Basic Information
| Provider Information | |||||||||
| NPI: | 1407997562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONIATTI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 E BENNETT ST | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187044940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702835611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 KACEY CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170559223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175910961 | ||||||||
| FaxNumber: | 7175910980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2007 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA002957L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 198927ZA9K | 01 | PA | MEDICARE PTAN | OTHER |