Provider Demographics
NPI:1144221664
Name:MATALA, KARA L (DO)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:L
Last Name:MATALA
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 1:3239 ELECTRIC RD
Mailing Address - Street 2:STE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6444
Mailing Address - Country:US
Mailing Address - Phone:540-904-7912
Mailing Address - Fax:
Practice Address - Street 1:171 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1950
Practice Address - Country:US
Practice Address - Phone:540-586-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH30945Medicare UPIN
VA080007907Medicare ID - Type Unspecified