Healthcare Provider Details

I. General information

NPI: 1184611204
Provider Name (Legal Business Name): KERRI MARIE MATEER P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 POPLAR CHURCH RD SUITE 400
CAMP HILL PA
17011-2203
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 717-724-6450
  • Fax: 717-724-6451
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052135
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: