Provider Demographics
NPI:1316955255
Name:MATULIS, STEVEN ROBERT (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:MATULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-342-0821
Mailing Address - Fax:304-345-6679
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 509
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-342-0821
Practice Address - Fax:304-345-6679
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14891207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0088400000Medicaid
0629402Medicare ID - Type Unspecified
WV1367AMedicare PIN
WV0088400000Medicaid