MEDICARE: TIMOTHY CARMALT MATLACK JR. MD

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
1	207P00000X	Emergency Medicine Physician	57.010206	OH

General Provider Information

NPI Number	:	1396959672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY CARMALT MATLACK JR. MD

Provider Business Mailing Address
First Line	:	1746 19TH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 EAST MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44309-2090
Country	:	US
Telephone Number	:	330-375-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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