Provider Demographics
NPI:1699714030
Name:STAINBROOK, MATTHEW TIMMINS (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TIMMINS
Last Name:STAINBROOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 W PARK AVE
Mailing Address - Street 2:STE. 6
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2277
Mailing Address - Country:US
Mailing Address - Phone:814-371-7590
Mailing Address - Fax:814-371-7579
Practice Address - Street 1:190 W PARK AVE
Practice Address - Street 2:STE. 6
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2277
Practice Address - Country:US
Practice Address - Phone:814-371-7590
Practice Address - Fax:814-371-7579
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009810L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180789OtherUNISON HEALTH PLAN
1548142OtherGATEWAY HEALTH PLAN
7239118OtherAETNA
PA1741708OtherHIGHMARK BLUE SHIELD
PA001972729002Medicaid
704495OtherUPMC HEALTH PLAN
180789OtherUNISON HEALTH PLAN
PAH18256Medicare UPIN