Individual
DR. MANDEEP S MATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 S MAIN ST, FORT WORTH, TX 76104-7611
(817) 927-3701
(817) 920-6924
Mailing address
1617 HEMPHILL ST, FORT WORTH, TX 76104-4709
(817) 927-3701
(817) 920-6924
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
256906
NY
207RI0200X
Infectious Disease Physician
Primary
256906
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03401810
—
NY
Enumeration date
05/04/2010
Last updated
06/16/2015
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