Provider Demographics
NPI:1619190717
Name:MATWIJECKY, CORNELIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:
Last Name:MATWIJECKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7402
Mailing Address - Country:US
Mailing Address - Phone:214-668-4487
Mailing Address - Fax:214-257-0240
Practice Address - Street 1:3505 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-7402
Practice Address - Country:US
Practice Address - Phone:214-668-4487
Practice Address - Fax:214-257-0240
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG43472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24665Medicare UPIN