MATTHEW ROBERT DETTRA


Address: 822 Pine St, Philadelphia, PA 19107-6187
Phone: 2675190154

MATTHEW ROBERT DETTRA (NPI# 1760041636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1760041636
Entity Type Individual
Full Name MATTHEW ROBERT DETTRA
Credential PA-C
Practice Address 822 Pine St
Philadelphia
PA 19107-6187
Mailing Address 484 Silver Ave
Southampton
PA 18966-3541
Practice Telephone 2675190154
Enumeration Date 2019-06-13
Last Update Date 2019-06-13
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 822 PINE ST
City PHILADELPHIA
State PA
Zip Code 19107-6187

Providers in the same location

NPI Name Taxonomy Address Enumeration
1427050913 Olga A. Katz Psychiatry & Neurology 822 Pine St, Suite C, Philadelphia, PA 19107-6187 2005-08-15
1497103139 Empowermeant Counseling, Coaching, and Consulting, LLC Community/Behavioral Health 822 Pine St, 2e, Philadelphia, PA 19107-6187 2016-06-02
1700287679 Ashley Dugan Psychologist 822 Pine St, #2f, Philadelphia, PA 19107-6187 2014-09-10
1841605649 Jennifer Claire Guglielmi Student in an Organized Health Care Education/Training Program 822 Pine St, 4b, Philadelphia, PA 19107-6187 2014-07-01
1134439037 Maureen P Kelly M.d.,pc Specialist 822 Pine St, Suite 4b, Philadelphia, PA 19107-6187 2010-10-14
1386951325 Susan Logiudice Social Worker 822 Pine St, Suite 2e, Philadelphia, PA 19107-6187 2010-09-13
1073833893 Olga Katz Md Phd LLC Psychiatry & Neurology 822 Pine St, Suite 1a, Philadelphia, PA 19107-6187 2010-06-03
1306163043 Richard Frederick Limoges, Md, Ltd Psychiatry & Neurology 822 Pine St, St. Regis Court, Suite 1b, Philadelphia, PA 19107-6187 2010-04-20
1093941510 David Ray Chen Internal Medicine 822 Pine St, Suite 3a, Philadelphia, PA 19107-6187 2009-06-10
1659542025 Advanced Neurology Associates, PC Clinic/Center 822 Pine St, Suite 3c, Philadelphia, PA 19107-6187 2008-03-13
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578170940 Stephanie Quist Pharmacist 1 S Broad Street, Philadelphia, PA 19107 2020-09-29
1457968448 Cloudline Physical Therapy LLC Physical Therapist 239-241 South 10th St, Philadelphia, PA 19107 2020-09-24
1053931303 Wilson Wong Pharmacist Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 2020-04-16
1326608779 Pascal Lavergne Neurological Surgery 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 2019-06-18
1639632185 Taylor D'amore Orthopaedic Surgery 925 Chest Street 5th Floor, Philadelphia, PA 19107 2019-04-11
1043779630 Heather Lynn Yenser Nurse Practitioner 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 2019-03-14
1174093702 Jennifer Lynn Kengeter Psychologist 900 Walnut Street, Suite 200, Philadelphia, PA 19107 2018-11-27
1649751843 Rachel Wint Physician Assistant 231 N Broad St Fl 2, Philadelphia, PA 19107 2018-08-24
1922588623 Hyung Bin Lee Dentist 315 N 12th St, Apt 803, Philadelphia, PA 19107 2018-08-21
1750860490 Anastasiya Khlypnych Physician Assistant 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 2018-08-13
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1467051763 Molly Catherine Peters Physician Assistant 4338 Boone St, Philadelphia, PA 19128-4901 2020-10-19
1356951024 Murielle M Boursiquot Physician Assistant 7901 Henry Ave Apt G302, Philadelphia, PA 19128-3072 2020-08-06
1134757156 Julie Hutchison Physician Assistant 2922 N 5th St, Philadelphia, PA 19133-2801 2020-03-27
1174155857 Rebecca Volpe Physician Assistant 738 Longshore Ave, Philadelphia, PA 19111-4325 2020-02-10
1306308879 Ria Raju Physician Assistant 7909 Lawndale Ave, Philadelphia, PA 19111-2652 2019-04-03
1386101400 Ashley Thomas Physician Assistant 9331 Old Bustleton Ave Ste 100a, Philadelphia, PA 19115 2019-02-25
1487119186 Shelby Elizabeth Ginsburg Physician Assistant 1200 W Tabor Rd Fl Bl4, Philadelphia, PA 19141-3019 2019-02-06
1346720059 Noelle Elizabeth Mullanaphy Physician Assistant 4031 Sheffield St, Philadelphia, PA 19136-3101 2018-08-21
1750860490 Anastasiya Khlypnych Physician Assistant 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 2018-08-13
1912409533 Lauren Joy Barton Physician Assistant 5401 N Broad St Ste 363, Philadelphia, PA 19141 2018-02-28
Find all providers in PHILADELPHIA

Competitor

Search similar providers

City PHILADELPHIA
Zip Code 19107

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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