MEDICARE: MATTHEW J GUEBLE 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
1	363AM0700X	Medical Physician Assistant	4719	CT

General Provider Information

NPI Number	:	1972130516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J GUEBLE PA-C

Provider Business Mailing Address
First Line	:	20 YORK STREET, CB-329
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3220
Country	:	US
Telephone Number	:	203-688-4748
Fax Number	:	203-688-4740

Provider Business Practice Location Address
First Line	:	20 YORK STREET
Second Line	:	NORTH PAVILION - FLOORS 9 & 10
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-0651
Country	:	US
Telephone Number	:	860-227-4735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	07/02/2020

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