MEDICARE: MATTHEW G MCCLURE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD457475	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	25MA09838900	NJ

General Provider Information

NPI Number	:	1124389028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW G MCCLURE MD

Provider Business Mailing Address
First Line	:	1865 ROUTE 70 E
Second Line	:	SUITE 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2013
Country	:	US
Telephone Number	:	856-433-2641
Fax Number	:	856-427-9468

Provider Business Practice Location Address
First Line	:	1865 ROUTE 70 E
Second Line	:	SUITE 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2013
Country	:	US
Telephone Number	:	856-433-2641
Fax Number	:	856-427-9468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	12/20/2016

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