Provider Demographics
NPI:1962583716
Name:MATTHEWS, MARIE COLETTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:COLETTE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:406 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1499
Mailing Address - Country:US
Mailing Address - Phone:814-827-9770
Mailing Address - Fax:814-827-3556
Practice Address - Street 1:406 W OAK ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1404
Practice Address - Country:US
Practice Address - Phone:814-827-9770
Practice Address - Fax:814-827-3556
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44717207Q00000X
CODR.0044717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00872563Medicaid
CO500095YL3FMedicare PIN
COC810528Medicare PIN