Healthcare Provider Details

I. General information

NPI: 1003880683
Provider Name (Legal Business Name): MATTHEW KELSEY REPPERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OVERBROOK RD
PAINTED POST NY
14870-9339
US

IV. Provider business mailing address

20 OVERBROOK RD
PAINTED POST NY
14870-9339
US

V. Phone/Fax

Practice location:
  • Phone: 607-368-0334
  • Fax:
Mailing address:
  • Phone: 607-368-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD044340E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number192911-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: