Individual
JACOB MATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Mailing address
2580 HAYMAKER RD STE 304, MONROEVILLE, PA 15146-3500
(412) 858-3070
(412) 858-3076
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA059271
PA
363AS0400X
Surgical Physician Assistant
Primary
MA059271
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103370830
—
PA
01
—
14128131
CAQH
—
Enumeration date
09/19/2017
Last updated
10/05/2020
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