Provider Demographics
NPI:1477628733
Name:MATTINGLY, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MATTINGLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:81 OLD YORK RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-517-5050
Mailing Address - Fax:215-517-4105
Practice Address - Street 1:81 OLD YORK ROAD
Practice Address - Street 2:SUITE 222
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-517-5050
Practice Address - Fax:215-517-4105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009360L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0722997000OtherBLUE CROSS PERSONAL CHOIC
PA1743575Medicaid
PA17435750006Medicaid
PA7123369OtherAETNA
PA32328OtherHEALTH PARTNERS
PA17435750006Medicaid
PA32328OtherHEALTH PARTNERS
PA0722997000OtherBLUE CROSS PERSONAL CHOIC