Active NPI
Lauren Matlack, MD
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1295574168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MT231888
- Practice address
- 3401 N Broad St
Philadelphia, PA 19140-5103 - Phone
- (215) 707-1800
- NPI assigned
- May 21, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MT231888 | PA | Primary |
Addresses
Primary practice location
3401 N Broad St
Philadelphia, PA 19140-5103
Mailing address
3401 N Broad St
Philadelphia, PA 19140-5103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240524002801 | PA | Order and Referring Only - Internal Medicine | 3678915410 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT231888 | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716249600000",
"number": "1295574168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405103",
"telephone_number": "215-707-1800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATLACK",
"first_name": "LAUREN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-21",
"last_updated": "2024-05-21",
"certification_date": "2024-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MT231888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.