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General NPI Number Information
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NPI Number | 1902467954
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Entity Type | Individual
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Provider Name | LIESL MATZKA MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 5 NEPONSET ST
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-721-1199
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Fax | 508-453-8019
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Provider Business Mailing Address
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Address Line | 5 NEPONSET ST
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-721-1199
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Fax | 508-453-8019
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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 | RT-3463
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 291855
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License Number State | MA
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