MEDICARE: MATTHEW B FORSYTHE CRNP

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	363LF0000X	Family Nurse Practitioner	SP019267	PA

General Provider Information

NPI Number	:	1407331911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW B FORSYTHE CRNP

Provider Business Mailing Address
First Line	:	5360 LINCOLN HWY
Second Line	:	STE 15
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5360 LINCOLN HWY
Second Line	:	STE 15
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	11/28/2018

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