Provider Demographics
NPI:1487807418
Name:MATEO, DINA LONDIE (PA)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:LONDIE
Last Name:MATEO
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 830624
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0624
Mailing Address - Country:US
Mailing Address - Phone:800-666-1816
Mailing Address - Fax:706-653-0615
Practice Address - Street 1:595 W STATE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2554
Practice Address - Country:US
Practice Address - Phone:215-481-4546
Practice Address - Fax:706-653-0615
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2024-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002668-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142176D2HMedicare PIN