Provider Demographics
NPI:1083864672
Name:INTERNAL MEDICINE OF BARBERTON, TERESA MATTY, M.D., INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF BARBERTON, TERESA MATTY, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-745-4188
Mailing Address - Street 1:101 5TH ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4225
Mailing Address - Country:US
Mailing Address - Phone:330-745-4188
Mailing Address - Fax:330-745-9244
Practice Address - Street 1:101 5TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4225
Practice Address - Country:US
Practice Address - Phone:330-745-4188
Practice Address - Fax:330-745-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH037175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346290Medicaid
OHMA0412372OtherMEDICARE ID TYPE UNSPECIFIED
OH=========OtherTAXPAYER IDENTIFICATION
OH0346290Medicaid