Healthcare Provider Details

I. General information

NPI: 1629185442
Provider Name (Legal Business Name): MATTHEW OWEN HURFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S 8TH ST HALL MERCER CMHC
PHILADELPHIA PA
19106-3520
US

IV. Provider business mailing address

245 S 8TH ST HALL MERCER CMHC
PHILADELPHIA PA
19106-3520
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5590
  • Fax: 215-829-8596
Mailing address:
  • Phone: 215-829-5590
  • Fax: 215-829-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD424988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: