| Doctor Name: | DR. MATTHEW R MATIASEK |
| NPI Number: | 1922127679 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 2005-0174 |
| Business Practice Address: | 3-2 Bas F St. Camp Lejeune, NC - 28547 |
| Business Phone Number: | 9104508051 |
| Business Fax Number: | |
| Mailing Address: | 3237 Eden St, CAMP LEJEUNE |
| State: | NC |
| Postal Code: | 285471406 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2005-0174 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |