Healthcare Provider Details

I. General information

NPI: 1265354732
Provider Name (Legal Business Name): CHRISTIAN JOSEPH MATRICCINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

76 TEABERRY DR
DRUMS PA
18222-2028
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-8000
  • Fax:
Mailing address:
  • Phone: 570-436-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA067469
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: