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Dr. Roman W Matlaga
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NPI Number Detailed Information
Provider Information:
| Name: | Dr. Roman W Matlaga |
| Gender: | M |
| Provider License Number If Given: | OS008779L |
NPI Information:
| NPI: | 1881688315 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 12/21/2010 |
Provider Business Mailing Address:
| Address: | 15 BODINE LN Honesdale, PA 18431 |
| Phone Number: | 5702539164 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 103 SPRUCE ST Hawley, PA 18428 |
| Phone Number: | 5703904545 |
| Fax Number: | 5703904546 |
Provider Taxonomy:
| Primary: | 207P00000X |
| Secondary (if any): | 207R00000X |
| State: | PA |
