Healthcare Provider Details

I. General information

NPI: 1770637357
Provider Name (Legal Business Name): HANSIE MARIE MATHELIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST 2C
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

51 N 39TH ST 2C
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9189
  • Fax: 856-216-7148
Mailing address:
  • Phone: 215-662-9189
  • Fax: 856-216-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD442816
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: