Healthcare Provider Details

I. General information

NPI: 1902442536
Provider Name (Legal Business Name): MATTHEW NEWCOMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AUGUSTA CIR
IRWIN PA
15642-3147
US

IV. Provider business mailing address

3500 VICTORIA ST
PITTSBURGH PA
15213-2543
US

V. Phone/Fax

Practice location:
  • Phone: 210-379-5578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN714775
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024192986
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A10874
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: