Provider Demographics
NPI:1982867461
Name:MATTHEWS, NICOLE ANDRE'A (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANDRE'A
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 LIMEKILN PIKE
Mailing Address - Street 2:APT #404
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2701
Mailing Address - Country:US
Mailing Address - Phone:215-416-7607
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0124012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry