MEDICARE: DR. MARC A MATOZZO DO

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	207Q00000X	Family Medicine Physician	OS009571L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437156098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC A MATOZZO DO

Provider Business Mailing Address
First Line	:	1028 W OREGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4421
Country	:	US
Telephone Number	:	215-389-7766
Fax Number	:	215-389-0227

Provider Business Practice Location Address
First Line	:	1028 W OREGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4421
Country	:	US
Telephone Number	:	215-389-7766
Fax Number	:	215-389-0227

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/15/2021

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