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NPI Code Detail

MEDICARE: MATTHEW THUJA PA-C

MEDICARE: MATTHEW THUJA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2020239OTHERNYLICENSE

General Provider Information

NPI Number : 1477003416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW THUJA PA-C
Provider Business Mailing Address
First Line : PO BOX 423
Second Line :
City : PENN YAN
State : NY
Zip : 14527-0423
Country : US
Telephone Number : 315-531-9102
Fax Number : 315-531-9103
Provider Business Practice Location Address
First Line : 7150 MAIN ST
Second Line :
City : OVID
State : NY
Zip : 14521-9401
Country : US
Telephone Number : 607-403-0065
Fax Number : 607-403-0093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 04/04/2017

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