Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | MD470613 | PA |
N | 207RC0200X | Critical Care Medicine | 273441 | NY |
N | 207RC0200X | Critical Care Medicine | MD470613 | PA |
N | 207RP1001X | Pulmonary Disease | 273441 | NY |
Y | 207RP1001X | Pulmonary Disease | MD470613 | PA |
NPI | 1124366869 |
---|---|
Provider Name | Ajsza Matela |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 30/06/2020 |