Provider Demographics
NPI:1245424084
Name:MATTA, MARK AYAD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:AYAD
Last Name:MATTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2616 WILMINGTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1504
Mailing Address - Country:US
Mailing Address - Phone:724-652-2323
Mailing Address - Fax:724-654-3461
Practice Address - Street 1:2616 WILMINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1504
Practice Address - Country:US
Practice Address - Phone:724-652-2323
Practice Address - Fax:724-654-3461
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2012-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA050132442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1984587OtherBCBS
PA1020636200001Medicaid
PA1020636200001Medicaid