Provider Demographics
NPI:1194138818
Name:MACKEN, MATTHEW ETHAN (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ETHAN
Last Name:MACKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:1020 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-1724
Practice Address - Country:US
Practice Address - Phone:412-313-0669
Practice Address - Fax:412-939-9965
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2023-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD461572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103333837-0001Medicaid
PA103333837-0002Medicaid