Provider Demographics
NPI:1558304972
Name:KING, MATTHEW JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6722
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:2310 CHRISTOPHER COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4206
Practice Address - Country:US
Practice Address - Phone:267-288-0389
Practice Address - Fax:267-288-0389
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064388207Q00000X
PAMD427802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410502800Medicaid
MD1761111OtherAETNA HMO
MD208803OtherJHHC PRODUCTS
MD9799126OtherAETNA PPO
MD0220704OtherCIGNA HEALTHCARE
MD9799126OtherAETNA PPO
MD239426Y5ZMedicare PIN
MD1761111OtherAETNA HMO