Provider Demographics
NPI:1750552089
Name:MATTILA-EVENDEN, MARJA ELINA (MD)
Entity type:Individual
Prefix:
First Name:MARJA
Middle Name:ELINA
Last Name:MATTILA-EVENDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARJA
Other - Middle Name:ELINA
Other - Last Name:MATTILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3535 MARKET STREET
Mailing Address - Street 2:3RD FLOOR.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-746-6700
Mailing Address - Fax:610-497-7525
Practice Address - Street 1:3535 MARKET STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-746-6700
Practice Address - Fax:610-874-7241
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4349722084P0800X, 2084P0802X
PAMT1852352084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry