Provider Demographics
NPI:1114946373
Name:MATISI, CATHERINE R (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:R
Last Name:MATISI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1957
Mailing Address - Country:US
Mailing Address - Phone:740-423-4225
Mailing Address - Fax:740-423-4228
Practice Address - Street 1:2515 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1957
Practice Address - Country:US
Practice Address - Phone:740-423-4225
Practice Address - Fax:740-423-4228
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2455669Medicaid
OHMA4069392Medicare ID - Type Unspecified
OH2455669Medicaid