Individual provider · Type 1 NPI
Matthew Robert Dettra, PA-C
Medical Physician Assistant · Fort Washington, PA
NPI number
1760041636
Active
Practice location
455 Pennsylvania Ave Ste 127
Fort Washington, PA 19034-3409
Fax (215) 412-3587
Other practice locations
- 1240 S Broad St Ste 200, Lansdale, PA 19446-5395 · (215) 361-3376
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
Another provider at this address
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- Katherine Victoria Moran, PA-CMedical Physician Assistant Fort Washington, PA NPI 1528374451
- Alfred Caldwell Warlick Iv, P.A.-CMedical Physician Assistant Fort Washington, PA NPI 1730463886
- Ashlie L. Glasgow, PA-CMedical Physician Assistant Fort Washington, PA NPI 1770062358
About NPI 1760041636
Matthew Robert Dettra, PA-C's National Provider Identifier is 1760041636, issued on Jun 13, 2019. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fort Washington, PA. The record was last updated on May 25, 2023.