Provider Demographics
NPI:1487832721
Name:EMILY W MATLIN DO PC
Entity Type:Organization
Organization Name:EMILY W MATLIN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-545-4224
Mailing Address - Street 1:4824 LONDONDERRY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5245
Mailing Address - Country:US
Mailing Address - Phone:717-545-4224
Mailing Address - Fax:717-545-5794
Practice Address - Street 1:4824 LONDONDERRY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5245
Practice Address - Country:US
Practice Address - Phone:717-545-4224
Practice Address - Fax:717-545-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005996L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA405855X7ZMedicare PIN