Provider Demographics
NPI:1902014046
Name:HILLIS, MATTHEW B (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:HILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:STE 25,STE 26
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 25,STE 26
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422318207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0031381000OtherIBC
00645139OtherRAILROAD MEDICARE
PA58229OtherAETNA
PA1022272770001Medicaid
0031381000OtherIBC