Provider Demographics
NPI:1235634767
Name:ATMATZIDIS, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ATMATZIDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SOUTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5350
Mailing Address - Country:US
Mailing Address - Phone:973-267-0300
Mailing Address - Fax:973-984-2670
Practice Address - Street 1:182 SOUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5350
Practice Address - Country:US
Practice Address - Phone:973-267-0300
Practice Address - Fax:973-984-2670
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11447900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology