Provider Demographics
NPI:1790768828
Name:MATEJICKA, COLLEEN (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MATEJICKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-299-1301
Mailing Address - Fax:717-299-2214
Practice Address - Street 1:2108 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-299-1301
Practice Address - Fax:717-299-2214
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009984L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018997900001Medicaid
PA1062166OtherAETNA HMO
PA1527199OtherGATEWAY HEALTH PLAN
PA7990688OtherAETNA NON-HMO
PAH62859OtherHEALTH ASSURANCE
PA1390245OtherHIGHMARK BLUE SHIELD
PA50000922OtherCAPITAL BLUE CROSS
PA1062166OtherAETNA HMO
PA50000922OtherCAPITAL BLUE CROSS