Provider Demographics
NPI:1881650174
Name:PANAHANDEH, MATTHEW R (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:PANAHANDEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:4000 HEMPFIELD PLAZA BLVD
Practice Address - Street 2:SUITE 963
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1483
Practice Address - Country:US
Practice Address - Phone:724-832-9300
Practice Address - Fax:724-832-9303
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067972L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001754238Medicaid
PA001754238Medicaid
PAH04770Medicare UPIN