Provider Demographics
NPI:1386872869
Name:MOODY, MATTHEW T (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:MOODY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 8500-8735
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3091
Practice Address - Country:US
Practice Address - Phone:215-456-6679
Practice Address - Fax:215-456-8502
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2021-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60693700207P00000X
PAOS015747207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine