Basic Information
| Provider Information | |||||||||
| NPI: | 1356364434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTZ | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 HIGBEE DRIVE | ||||||||
| Address2: | SUITE B102 | ||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128358090 | ||||||||
| FaxNumber: | 4128358044 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 HIGBEE DRIVE | ||||||||
| Address2: | SUITE B102 | ||||||||
| City: | BETHEL PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128358090 | ||||||||
| FaxNumber: | 4128358044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 044743E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0011901890003 | 05 | PA | MEDICAID | 5385295 | 01 | PA | HIGHMARK BC/BS | OTHER | 00119018900015 | 05 | PA | MEDICAID | 819548 | 01 | PA | AETNA | OTHER | 8810 | 01 | PA | HEALTH AMERICA | OTHER | 0011901890002 | 05 | PA | MEDICAID | 080023340 | 01 | PA | RAILROAD MEDICARE | OTHER | 0011901890006 | 05 | PA | MEDICAID | 102149 | 01 | PA | UPMC | OTHER |