Healthcare Provider Details

I. General information

NPI: 1790768828
Provider Name (Legal Business Name): COLLEEN MATEJICKA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 HARRISBURG PIKE SUITE 200
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2108 HARRISBURG PIKE SUITE 200
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-1301
  • Fax: 717-299-2214
Mailing address:
  • Phone: 717-299-1301
  • Fax: 717-299-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS009984L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: