Provider Demographics
NPI:1821351925
Name:DIMATTEO, MOLLY K (DO)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:DIMATTEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:K
Other - Last Name:SPORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6998 CRIDER ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2390
Mailing Address - Country:US
Mailing Address - Phone:724-778-1601
Mailing Address - Fax:724-778-1603
Practice Address - Street 1:6998 CRIDER RD STE 210
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2390
Practice Address - Country:US
Practice Address - Phone:724-778-1601
Practice Address - Fax:724-778-1603
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103302106Medicaid
PA103302106Medicaid