Healthcare Provider Details

I. General information

NPI: 1225828056
Provider Name (Legal Business Name): MATTHEW CHRISTOPHER BUSHIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MELLON WAY
LATROBE PA
15650-1197
US

IV. Provider business mailing address

1581 CRAIG DR
IRWIN PA
15642-1714
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1000
  • Fax:
Mailing address:
  • Phone: 724-689-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT024341
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: