Provider Demographics
NPI:1508813288
Name:MATZONI, FAITH JABERS (DO)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:JABERS
Last Name:MATZONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:JUSTINE
Other - Last Name:JABERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4000 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1017
Mailing Address - Country:US
Mailing Address - Phone:717-231-8508
Mailing Address - Fax:717-231-8535
Practice Address - Street 1:4000 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1017
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0008187207R00000X, 208M00000X
PAOS008650L208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001691334Medicaid
PA001691334Medicaid
MDG68696Medicare UPIN
PA0016913340006Medicaid
PA008292Medicare PIN
DE1508813288Medicaid
DE021216B86OtherRAILROAD MEDICARE
DE522011HOSOtherBCBS OF DE - HOSPITALIST
PA008292D99Medicare PIN
DE1508813288OtherDE PHYSICIAN CARE - MCAID
PA001691334 0005Medicaid
MD211NMedicare PIN