Provider Demographics
NPI:1720147267
Name:MATUSKA, MARCIA A (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:MATUSKA
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 1:76 HIGH ST
Mailing Address - Street 2:SUITE 305A
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7649
Mailing Address - Country:US
Mailing Address - Phone:207-777-7149
Mailing Address - Fax:207-782-1336
Practice Address - Street 1:76 HIGH ST
Practice Address - Street 2:SUITE 305A
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7649
Practice Address - Country:US
Practice Address - Phone:207-777-7149
Practice Address - Fax:207-782-1336
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012373207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM1015Medicare ID - Type Unspecified
D03608Medicare UPIN