Provider Demographics
NPI:1700958428
Name:SIPPLE, MATHEW W (DO)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:W
Last Name:SIPPLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MATHEW
Other - Middle Name:WALTER
Other - Last Name:SIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3250 W. LAKE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3691
Mailing Address - Country:US
Mailing Address - Phone:814-790-4567
Mailing Address - Fax:814-295-4074
Practice Address - Street 1:3250 W. LAKE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3691
Practice Address - Country:US
Practice Address - Phone:814-790-4567
Practice Address - Fax:814-295-4074
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0134572084P0800X
PAOS134572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025630550005Medicaid