Provider Demographics
NPI:1194715441
Name:MATTO, PATRICIA LYN (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYN
Last Name:MATTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MATTO
Other - Last Name:RUOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1702 CATHERINE CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 CATHERINE CT STE 1A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5790
Practice Address - Country:US
Practice Address - Phone:334-501-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007023M207Q00000X
VA0102203314207Q00000X
ALDO.2755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194715441Medicaid
OH2412044Medicaid
OHMA4137111Medicare ID - Type Unspecified
OH2412044Medicaid