Provider Demographics
NPI:1669524088
Name:OLIVO, MATTHEW PETER (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:OLIVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2860
Mailing Address - Country:US
Mailing Address - Phone:856-854-0300
Mailing Address - Fax:856-854-4107
Practice Address - Street 1:201 HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2860
Practice Address - Country:US
Practice Address - Phone:856-854-0300
Practice Address - Fax:856-854-4107
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04753100207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06747Medicare UPIN