Provider Demographics
NPI:1164495354
Name:MATTERN, JOHN QA (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:QA
Last Name:MATTERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-4075
Practice Address - Fax:540-932-5199
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201424208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5748409OtherCIGNA
VA5886945OtherVA PREMIER
VA64916OtherOPTIMA
VA2202367OtherFIRST HEALTH
VA466150OtherANTHEM
VA005886945Medicaid
VA210242OtherSOUTHERN HEALTH
VA64916OtherOPTIMA
VA5886945OtherVA PREMIER
VA2202367OtherFIRST HEALTH
VAP00174317Medicare PIN
VAC02675Medicare PIN