MEDICARE: DR. MONIQUE MATUSKOWITZ D.O.

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	0102201471	VA
2	207Q00000X	Family Medicine Physician	N0256	TX

General Provider Information

NPI Number	:	1821073743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE MATUSKOWITZ D.O.

Provider Business Mailing Address
First Line	:	3938 E OCEAN VIEW AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23518-1525
Country	:	US
Telephone Number	:	281-254-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	3938 E OCEAN VIEW AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23518-1525
Country	:	US
Telephone Number	:	281-254-0014
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/01/2014

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