MEDICARE: DR. MATTHEW JOHN KING M.D.

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	D0064388	MD
2	207Q00000X	Family Medicine Physician	MD427802	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0220704	OTHER	MD	CIGNA HEALTHCARE
2	208803	OTHER	MD	JHHC PRODUCTS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1761111	OTHER	MD	AETNA HMO
5	9799126	OTHER	MD	AETNA PPO

General Provider Information

NPI Number	:	1558304972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JOHN KING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746722
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6722
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	2310 CHRISTOPHER COLUMBUS BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4206
Country	:	US
Telephone Number	:	267-288-0389
Fax Number	:	267-288-0389

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/30/2025

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