Healthcare Provider Details

I. General information

NPI: 1811910391
Provider Name (Legal Business Name): MICHAEL LYN MATTERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/20/2012
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

640 S STATE ST 742 BLDG
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-3416
  • Fax: 302-734-4960
Mailing address:
  • Phone: 302-674-3970
  • Fax: 302-672-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC1-0002009
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: