Provider Demographics
NPI:1285061804
Name:MATEJKA, ROSEMARY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:M
Last Name:MATEJKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:942 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2314
Mailing Address - Country:US
Mailing Address - Phone:617-325-0520
Mailing Address - Fax:617-325-9047
Practice Address - Street 1:942 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2314
Practice Address - Country:US
Practice Address - Phone:617-325-0520
Practice Address - Fax:617-325-9047
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical