Provider Demographics
NPI:1518914886
Name:AUSTIN, MATTHEW STUART (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STUART
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HARRITON RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1813
Mailing Address - Country:US
Mailing Address - Phone:215-219-9449
Mailing Address - Fax:
Practice Address - Street 1:523 E 72ND ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4099
Practice Address - Country:US
Practice Address - Phone:212-606-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307193207XS0114X
NJ25MA07688400207XS0114X
PAMD071927L207XS0114X
FLME152687207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2313094000OtherIBC
6848606OtherCIGNA
PA1175701OtherAETNA
PA2313094000OtherIBC
I07575Medicare UPIN
I07575Medicare UPIN