Provider Demographics
NPI:1699954073
Name:MATSKO, JANINE ANN (MD)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:ANN
Last Name:MATSKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PHILIP PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3902
Mailing Address - Country:US
Mailing Address - Phone:215-925-4175
Mailing Address - Fax:215-925-8448
Practice Address - Street 1:250 PHILIP PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3902
Practice Address - Country:US
Practice Address - Phone:215-925-4175
Practice Address - Fax:215-925-8448
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019891E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28613Medicare UPIN