Provider Demographics
NPI:1811910391
Name:MATTERN, MICHAEL LYN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYN
Last Name:MATTERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:742 BLDG
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-674-3970
Mailing Address - Fax:302-672-2350
Practice Address - Street 1:724 S NEW ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3540
Practice Address - Country:US
Practice Address - Phone:302-734-3416
Practice Address - Fax:302-734-4960
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0002009207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000130101Medicaid
DE066938M86Medicare PIN
DE0000130101Medicaid