Healthcare Provider Details

I. General information

NPI: 1831081363
Provider Name (Legal Business Name): MATTHEW JAMES HULSE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WARREN AVE STE 206
WILLIAMSPORT PA
17701-2664
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-326-8090
  • Fax:
Mailing address:
  • Phone: 570-326-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: