Healthcare Provider Details

I. General information

NPI: 1104819283
Provider Name (Legal Business Name): ROBERT PAUL MATSKO JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 GOOD HOPE RD
ENOLA PA
17025-1233
US

IV. Provider business mailing address

1824 GOOD HOPE RD
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 717-732-8877
  • Fax:
Mailing address:
  • Phone: 717-732-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-010593L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: