Individual
DR. MARK MATTAR
Active
Individual
DR. MARK MATTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101247425
VA
207RG0100X
Gastroenterology Physician
A95008
CA
207RG0100X
Gastroenterology Physician
Primary
MD036652
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12120494
CAQH
VA
Enumeration date
05/27/2007
Last updated
01/17/2019
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