Provider Demographics
NPI:1962499418
Name:FORTE, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:FORTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:40 VALLEY STREAM PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:610-644-8909
Practice Address - Street 1:15 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2222
Practice Address - Country:US
Practice Address - Phone:914-683-9729
Practice Address - Fax:914-683-9730
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA075783002085R0202X
RI106552085R0204X
NY263633-12085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010260Medicaid
NY03511346Medicaid
NJ072340Q9EMedicare PIN
NY03511346Medicaid
NJ0010260Medicaid