Provider Demographics
NPI:1649620089
Name:PARKER, MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:PARKER
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 1:2040 MARKET ST APT 1121
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3369
Mailing Address - Country:US
Mailing Address - Phone:916-709-0825
Mailing Address - Fax:
Practice Address - Street 1:2040 MARKET ST APT 1121
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3369
Practice Address - Country:US
Practice Address - Phone:916-709-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0173342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry