Individual
MATHEW M EDAVETTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 N DUKE ST, LANCASTER, PA 17602-2250
(717) 544-5511
Mailing address
555 N DUKE ST, LANCASTER, PA 17602-2250
(717) 544-5511
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD437555
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD437555
PA MEDICAL LICENSE
PA
Enumeration date
06/29/2009
Last updated
06/29/2009
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