Provider Demographics
NPI:1801087978
Name:MATIN, AYAZ (MD)
Entity type:Individual
Prefix:
First Name:AYAZ
Middle Name:
Last Name:MATIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2433
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2433
Mailing Address - Country:US
Mailing Address - Phone:484-526-7575
Mailing Address - Fax:484-526-7576
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-7575
Practice Address - Fax:484-526-7576
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432229207R00000X, 208M00000X, 207RG0100X
NY262338207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102003837Medicaid
PA102003837Medicaid