Provider Demographics
NPI:1679525935
Name:MATTA, ROBERT A (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MATTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:3050 HAMILTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3691
Practice Address - Country:US
Practice Address - Phone:610-432-2013
Practice Address - Fax:610-432-6559
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007214L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012679720004Medicaid
PA703245OtherHIGHMARK PA BLUE SHIELD
PA080079948OtherPALMETTO RR
PA01036701OtherCAPITAL BLUE CROSS
PA703245LH5Medicare PIN
PA01036701OtherCAPITAL BLUE CROSS