Healthcare Provider Details

I. General information

NPI: 1386058659
Provider Name (Legal Business Name): ANDREW MATHEW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 NORLAND AVE
CHAMBERSBURG PA
17201-4217
US

IV. Provider business mailing address

830 NORLAND AVE
CHAMBERSBURG PA
17201-4217
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6881
  • Fax: 717-217-6889
Mailing address:
  • Phone: 717-217-6881
  • Fax: 717-217-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS021965
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberOS021965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: