=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366749889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW LOUIS KEARNEY P.A.-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11110 MEDICAL CAMPUS RD STE 200
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-6797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-714-4400
-----------------------------------------------------
Fax | 301-714-4424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11110 MEDICAL CAMPUS RD STE 200
-----------------------------------------------------
City | HAGERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21742-6797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-714-4400
-----------------------------------------------------
Fax | 301-714-4424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | C04440
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------