Provider Demographics
NPI:1033232723
Name:VAN DEUSEN, MATHEW A (MD)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:A
Last Name:VAN DEUSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALLEGHENY CTR FL 7
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5227
Mailing Address - Country:US
Mailing Address - Phone:412-330-2510
Mailing Address - Fax:412-330-5844
Practice Address - Street 1:575 COAL VALLEY RD STE 504
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3729
Practice Address - Country:US
Practice Address - Phone:412-359-6137
Practice Address - Fax:412-359-4334
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420804208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009106Medicaid
OH2750698Medicaid
PA1019385410001Medicaid
PA113877PNLMedicare PIN