Provider Demographics
NPI:1619230885
Name:DIIULIO, MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DIIULIO
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 1:1001 WATERDAM PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2466
Mailing Address - Country:US
Mailing Address - Phone:724-969-1001
Mailing Address - Fax:724-260-5884
Practice Address - Street 1:1001 WATERDAM PLAZA DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2466
Practice Address - Country:US
Practice Address - Phone:724-969-1001
Practice Address - Fax:724-260-5884
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875375Medicare PIN