Healthcare Provider Details

I. General information

NPI: 1013466028
Provider Name (Legal Business Name): MATTHEW JOHN PONTORIERO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DAUGHERTY DR SUITE 301
MONROEVILLE PA
15146-2749
US

IV. Provider business mailing address

125 DAUGHERTY DR SUITE 301
MONROEVILLE PA
15146-2749
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA0585891
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: