Provider Demographics
NPI:1851384085
Name:HALEY, MATTHEW C (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
Last Name:HALEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3702
Mailing Address - Country:US
Mailing Address - Phone:570-288-5441
Mailing Address - Fax:570-288-5842
Practice Address - Street 1:10 DUNDAFF ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1869
Practice Address - Country:US
Practice Address - Phone:570-282-1404
Practice Address - Fax:570-281-3373
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009640L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003088OtherFIRST PRIORITY HEALTH
PA001703829Medicaid
PA816752OtherFIRST PRIORITY HEALTH
PA976634OtherBLUE SHIELD
PA1997926OtherHIGHMARK BLUE SHIELD
PA930086707OtherRAILROAD MEDICARE
PA816752OtherFIRST PRIORITY HEALTH
PA014767NUTMedicare PIN
PA119963Medicare Oscar/Certification
PA930086707OtherRAILROAD MEDICARE