Provider Demographics
NPI:1699702597
Name:MATTHAI, WILLIAM HENRY JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:MATTHAI
Suffix:JR
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 1:51 NORTH 39TH STREET
Mailing Address - Street 2:4 PHI
Mailing Address - City:PHILADELPHIA,
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-9189
Mailing Address - Fax:215-243-4612
Practice Address - Street 1:51 NORTH 39TH STREET
Practice Address - Street 2:4 PHI
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9189
Practice Address - Fax:215-243-4612
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05637200207RC0000X
PAMD034664E207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011712360001Medicaid
PA003782Medicare PIN
E23197Medicare UPIN