Provider Demographics
NPI:1679529929
Name:MATUSIC, BRYAN P (DO)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:P
Last Name:MATUSIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3155
Mailing Address - Fax:412-359-3483
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3155
Practice Address - Fax:412-359-3483
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012348207L00000X
WV2156207L00000X
OH34-008766207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00609415OtherRR MEDICARE OH
WVP00404736OtherMEDICARE RR
OH4191591Medicare PIN
OHP00609415OtherRR MEDICARE OH
WV4191592Medicare PIN
WV4191603Medicare PIN
WV4191602Medicare PIN