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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
822 PINE ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19107-6187 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 19107 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| 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 | ||||
| City | PHILADELPHIA |
| Zip Code | 19107 |
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| 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.