Provider Demographics
NPI:1578191664
Name:DEICKE, MATTHEW DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:DEICKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE B300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4775
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:
Practice Address - Street 1:1307 FEDERAL ST STE B300
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4775
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine