Provider Demographics
NPI:1255778619
Name:PANTELL, MATTHEW SHANNON (MD, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SHANNON
Last Name:PANTELL
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UC SAN FRANCISCO M691
Mailing Address - Street 2:505 PARNASSUS, BOX 0110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0110
Mailing Address - Country:US
Mailing Address - Phone:415-476-6245
Mailing Address - Fax:
Practice Address - Street 1:UC SAN FRANCISCO M691
Practice Address - Street 2:505 PARNASSUS, BOX 0110
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0110
Practice Address - Country:US
Practice Address - Phone:415-476-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program