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General NPI Number Information
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NPI Number | 1477628733
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Entity Type | Individual
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Provider Name | DAVID L MATTINGLY DO
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 81 OLD YORK ROAD SUITE 222
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City | JENKINTOWN
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State | PA
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Zip | 19046
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Country | US
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Telephone | 215-517-5050
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Fax | 215-517-4105
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Provider Business Mailing Address
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Address Line | 81 OLD YORK RD SUITE 222
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City | JENKINTOWN
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State | PA
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Zip | 19046
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Country | US
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Telephone | 215-517-5050
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Fax | 215-517-4105
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS009360L
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License Number State | PA
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