Provider Demographics
NPI:1356548978
Name:NUSSBAUM, MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 W HAMILTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6470
Mailing Address - Country:US
Mailing Address - Phone:610-776-1603
Mailing Address - Fax:
Practice Address - Street 1:1941 W HAMILTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6470
Practice Address - Country:US
Practice Address - Phone:610-776-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine