Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC004374L | PA |
NPI | 1073519633 |
---|---|
Provider Name | Dr. Carl J Mattia |
First Address | Newtown, PA 18940-1738 |
Second Address | Yardley, PA 19067-7706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 30/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017888350005 | (05) | PA |
U74890 | (02) | PA |