Healthcare Provider Details

I. General information

NPI: 1508236084
Provider Name (Legal Business Name): MATTHEW WESTERVELT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E OREGON RD
LITITZ PA
17543-9202
US

IV. Provider business mailing address

640 E OREGON RD
LITITZ PA
17543-9202
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-8773
  • Fax:
Mailing address:
  • Phone: 717-569-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057881
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: