STANLEY JOSEPH MATYASIK DO, NPI 1003951625 — CUMBERLAND (MD)

NPI 1003951625

13+ Years Experience Individual

STANLEY JOSEPH MATYASIK DO

02/21/2007
PROVIDER ENUMERATION DATE
06/15/2018
LAST UPDATE DATE
1003951625
NPI NUMBER

About STANLEY JOSEPH MATYASIK

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

STANLEY JOSEPH MATYASIK is a provider established in CUMBERLAND, MD. The NPI number of STANLEY JOSEPH MATYASIK is 1003951625 and was assigned on 02/21/2007. The practitioners primary taxonomy code is: 207RP1001X with license number: H0053855 MD .

Mailing address

  • City: CUMBERLAND
  • State: MD
  • Postal code: 21502
  • Phone: 2409648690
  • Fax: 2409648699
  • Address: 12502 WILLOWBROOK RD
  • Address 2: MEDICAL ARTS CENTER SUITE 280

Primary Practice Address

  • Region : CUMBERLAND, MD
  • NPI : 1003951625
  • Phone : 2409648690
  • Fax : 2409648699
  • Postalcode : 21502
  • Address : 12502 WILLOWBROOK ROAD SUITE 280

Additional identifiers

  • Identifier: 144201500
  • Code / Type : 5 - MEDICAID
  • Identifier state : MD

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Internal Medicine

  • Taxonomy code: 207RP1001X
  • License number: H0053855
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Contacts:

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  • STANLEY JOSEPH MATYASIK DO
  • Address : 12502 WILLOWBROOK ROAD SUITE 280
  • Region : CUMBERLAND, MD
  • NPI : 1003951625
  • Phone : 2409648690
  • Fax : 2409648699
  • Postalcode : 21502

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address12502 WILLOWBROOK ROAD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 280
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCUMBERLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code21502
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number2409648690
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2409648699
The fax number associated with the location address of the provider being identified.
NPI1003951625
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1207RP1001X
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.
Provider Enumeration Date02/21/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06/15/2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)STANLEY JOSEPH MATYASIK
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address12502 WILLOWBROOK RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressMEDICAL ARTS CENTER SUITE 280
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCUMBERLAND
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code21502
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number2409648690
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number2409648699
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1207RP1001X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Internal Medicine
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.
Provider License Number 1H0053855
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1144201500
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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