Individual
DR. MATTHEW KELSEY REPPERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 OVERBROOK RD, PAINTED POST, NY 14870-9339
(607) 368-0334
Mailing address
20 OVERBROOK RD, PAINTED POST, NY 14870-9339
(607) 368-0334
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
192911-1
NY
208600000X
Surgery Physician
MD044340E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014394690003
—
PA
05
—
01431621
—
NY
01
—
020049791
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
Enumeration date
02/13/2006
Last updated
06/09/2015
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