Provider Demographics
NPI:1912298449
Name:STEPHENS, MATTHEW ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9242
Mailing Address - Country:US
Mailing Address - Phone:570-814-7456
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-988-0000
Practice Address - Fax:717-792-5716
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451454207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine