Provider Demographics
NPI:1538178686
Name:SAMUEL, MATHEW P (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:P
Last Name:SAMUEL
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8923
Mailing Address - Fax:
Practice Address - Street 1:1845 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1703
Practice Address - Country:US
Practice Address - Phone:717-231-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30450207RR0500X
WV28637207RR0500X
PAMD049288L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000052177OtherBLUE CROSS
OH0162489Medicaid
KY64304504Medicaid
F88420Medicare UPIN
KY64304504Medicaid