Healthcare Provider Details

I. General information

NPI: 1851384085
Provider Name (Legal Business Name): MATTHEW C HALEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUNDAFF ST
CARBONDALE PA
18407-1869
US

IV. Provider business mailing address

610 WYOMING AVE
KINGSTON PA
18704-3702
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-1404
  • Fax: 570-281-3373
Mailing address:
  • Phone: 570-288-5441
  • Fax: 570-288-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009640L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: