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NPI Code Detail

MEDICARE: MADISON NICOLE MATELLO PA-C

MEDICARE: MADISON NICOLE MATELLO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantMA065194PA

General Provider Information

NPI Number : 1114793783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON NICOLE MATELLO PA-C
Provider Business Mailing Address
First Line : 1080 N DELAWARE AVE STE 800
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-4338
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1080 N DELAWARE AVE STE 800
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-4338
Country : US
Telephone Number : 267-463-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2023
Last Update Date : 01/14/2026

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Directions to “ MADISON NICOLE MATELLO PA-C” Practice Location

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