Provider Demographics
NPI:1558190991
Name:BULKLEY, MATTHEW TYLER (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TYLER
Last Name:BULKLEY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:611 SPRINGHOUSE RD APT L
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4693
Mailing Address - Country:US
Mailing Address - Phone:570-637-2459
Mailing Address - Fax:
Practice Address - Street 1:250 REITZ BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9208
Practice Address - Country:US
Practice Address - Phone:570-523-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant