MEDICARE: MATTHEW CHRISTOPHER HENRY

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	146N00000X	Basic Emergency Medical Technician	149773	PA

General Provider Information

NPI Number	:	1982695946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHRISTOPHER HENRY

Provider Business Mailing Address
First Line	:	2098 BUTLER PIKE
Second Line	:	APT E4
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1839
Country	:	US
Telephone Number	:	610-730-8939
Fax Number	:

Provider Business Practice Location Address
First Line	:	5550 N WALNUT ST
Second Line	:
City	:	MACUNGIE
State	:	PA
Zip	:	18062-1323
Country	:	US
Telephone Number	:	610-966-2601
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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