Healthcare Provider Details

I. General information

NPI: 1932665189
Provider Name (Legal Business Name): MATTHEW MELCZAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 PINE HOLLOW RD
MC KEES ROCKS PA
15136-1661
US

IV. Provider business mailing address

179 PINCHTOWN RD
PITTSBURGH PA
15236-1132
US

V. Phone/Fax

Practice location:
  • Phone: 412-771-1055
  • Fax:
Mailing address:
  • Phone: 412-592-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT027507
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPT027507
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerALL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: