Provider Demographics
NPI:1275997959
Name:MATANI, NEDAL
Entity Type:Individual
Prefix:
First Name:NEDAL
Middle Name:
Last Name:MATANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LAKE FORGETFUL APT 629
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8286
Mailing Address - Country:US
Mailing Address - Phone:862-763-2653
Mailing Address - Fax:
Practice Address - Street 1:27 LAKE FORGETFUL APT 629
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8286
Practice Address - Country:US
Practice Address - Phone:862-763-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26067208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist