Healthcare Provider Details

I. General information

NPI: 1316344724
Provider Name (Legal Business Name): MATTHEW MCHUGH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E HIGH ST
POTTSTOWN PA
19464-5008
US

IV. Provider business mailing address

3434 E ORVILLA RD
HATFIELD PA
19440-2065
US

V. Phone/Fax

Practice location:
  • Phone: 610-705-6903
  • Fax:
Mailing address:
  • Phone: 215-919-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN583823
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number106135
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: