Provider Demographics
NPI:1063647543
Name:MATUSZKIEWICZ, MARCIN (MD)
Entity Type:Individual
Prefix:
First Name:MARCIN
Middle Name:
Last Name:MATUSZKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3201
Mailing Address - Country:US
Mailing Address - Phone:707-923-3925
Mailing Address - Fax:707-923-3902
Practice Address - Street 1:509 ELM ST
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3204
Practice Address - Country:US
Practice Address - Phone:707-923-3925
Practice Address - Fax:707-923-3902
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195526207Q00000X, 390200000X
CAA120885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program