Healthcare Provider Details

I. General information

NPI: 1073532990
Provider Name (Legal Business Name): MATTERN & ASSOCIATES, MD'S, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S NEW ST
DOVER DE
19904-3540
US

IV. Provider business mailing address

724 S NEW ST
DOVER DE
19904-3540
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-3416
  • Fax: 302-734-4960
Mailing address:
  • Phone: 302-734-3416
  • Fax: 302-734-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1989020815
License Number StateDE

VIII. Authorized Official

Name: JANE MATTERN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 302-734-3416