Healthcare Provider Details

I. General information

NPI: 1639081904
Provider Name (Legal Business Name): CHRISTOPHER MATLICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 LIMESTONE RD
KEYSER WV
26726-9710
US

IV. Provider business mailing address

3703 LIMESTONE RD
KEYSER WV
26726-9710
US

V. Phone/Fax

Practice location:
  • Phone: 304-813-3960
  • Fax:
Mailing address:
  • Phone: 304-813-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: