Healthcare Provider Details

I. General information

NPI: 1982604138
Provider Name (Legal Business Name): MATTHEW PLOTKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST.
PHILADELPHIA PA
19104-4228
US

IV. Provider business mailing address

3400 SPRUCE ST.
PHILADELPHIA PA
19104-4228
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2638
  • Fax: 215-349-5703
Mailing address:
  • Phone: 215-662-2638
  • Fax: 215-349-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD477169
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD477169
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: