Healthcare Provider Details

I. General information

NPI: 1922331503
Provider Name (Legal Business Name): MATTHEW SCOTT BIDLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL VIA CONTRADA BOSCARIELLO
GIRCIGNANO DI AVERSA CE
81030
IT

IV. Provider business mailing address

PSC 808 BOX 19
FPO AE
09618-0001
US

V. Phone/Fax

Practice location:
  • Phone: 81-811-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA115011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: