Healthcare Provider Details

I. General information

NPI: 1407331911
Provider Name (Legal Business Name): MATTHEW B FORSYTHE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 LINCOLN HWY STE 15
GAP PA
17527-9451
US

IV. Provider business mailing address

5360 LINCOLN HWY STE 15
GAP PA
17527-9451
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-8111
  • Fax:
Mailing address:
  • Phone: 717-442-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019267
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: