Provider Demographics
NPI:1427160183
Name:MATTA, HARRY J (DO)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:MATTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S FRONT ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003326L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006722360002Medicaid
PA0006722360003Medicaid
PA1514807OtherGATEWAY
PA300024888OtherKEYSTONE MERCY
PA000160562OtherHIGHMARK BS
PA144139OtherUNISON
PA34659OtherGEISINGER
PA50010130OtherCAPITAL BC
PA000160562OtherHIGHMARK BS
PAC32339Medicare UPIN
PAP00013509Medicare PIN