Individual
DR. EILEEN MATLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, SUITE 8490, PHILADELPHIA, PA 19107-4824
(215) 955-6161
(215) 923-5507
Mailing address
111 S 11TH ST, SUITE 8490, PHILADELPHIA, PA 19107-4824
(215) 955-6161
(215) 923-5507
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD026451E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000952820
—
PA
05
—
8329800
—
NJ
Enumeration date
07/11/2006
Last updated
09/16/2014
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