Provider Demographics
NPI:1710665823
Name:MATTIVI, MICHAELA (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MATTIVI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9335
Mailing Address - Country:US
Mailing Address - Phone:412-208-5996
Mailing Address - Fax:
Practice Address - Street 1:5115 CENTRE AVE FL 4
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1301
Practice Address - Country:US
Practice Address - Phone:412-864-6600
Practice Address - Fax:412-864-6667
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant