Provider Demographics
NPI:1780904763
Name:WALTON, MATTHEW GARY (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GARY
Last Name:WALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3749
Mailing Address - Country:US
Mailing Address - Phone:412-466-5502
Mailing Address - Fax:412-469-8948
Practice Address - Street 1:1200 BROOKS LN STE 110
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3749
Practice Address - Country:US
Practice Address - Phone:412-466-5502
Practice Address - Fax:412-469-8948
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine