Provider Demographics
NPI:1073519633
Name:MATTIA, CARL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:J
Last Name:MATTIA
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:638 NEWTOWN YARDLEY RD
Mailing Address - Street 2:STE 1H
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1738
Mailing Address - Country:US
Mailing Address - Phone:215-794-7553
Mailing Address - Fax:215-794-5379
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 904 A & B
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:215-321-1200
Practice Address - Fax:215-321-6100
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2018-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASC004374L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017888350005Medicaid
PA0017888350005Medicaid
PA026664KCSMedicare PIN
PA6191300001Medicare NSC