Provider Demographics
NPI:1275744088
Name:PSYCH-MED ASSOCIATES INC
Entity Type:Organization
Organization Name:PSYCH-MED ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-652-2323
Mailing Address - Street 1:2616 WILMINGTON ROAD
Mailing Address - Street 2:
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 ROAD
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA952086OtherBCBS PA TRADITIONAL
PA1312782OtherBCBS PA BEHAVIORAL HEALTH
PA0015112670001Medicaid
PA050743Medicare PIN
PA0015112670001Medicaid