Provider Demographics
NPI:1003951625
Name:MATYASIK, STANLEY JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOSEPH
Last Name:MATYASIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JOHNSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2372
Mailing Address - Country:US
Mailing Address - Phone:740-231-4484
Mailing Address - Fax:740-672-3595
Practice Address - Street 1:4100 JOHNSON RD STE 202
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2372
Practice Address - Country:US
Practice Address - Phone:740-314-8438
Practice Address - Fax:740-672-3595
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013226207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293411Medicaid
G05275Medicare UPIN
MD144201500Medicaid