Provider Demographics
NPI:1780786277
Name:MERTZ, MATTHEW OWEN (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:OWEN
Last Name:MERTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2163
Mailing Address - Country:US
Mailing Address - Phone:610-377-2490
Mailing Address - Fax:
Practice Address - Street 1:215 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2163
Practice Address - Country:US
Practice Address - Phone:610-377-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004246L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50804OtherGEISINGER
PA1020161740001Medicaid
PAU68627Medicare UPIN
PA004447ZF2YMedicare PIN