Provider Demographics
NPI:1144279035
Name:KARLEN, MATTHEW R (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:KARLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH ASHLEY DRIVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5318
Mailing Address - Country:US
Mailing Address - Phone:813-833-6220
Mailing Address - Fax:813-985-8006
Practice Address - Street 1:100 SOUTH ASHLEY DRIVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5318
Practice Address - Country:US
Practice Address - Phone:813-833-6220
Practice Address - Fax:813-985-8006
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350863732085R0202X
FLME1095552085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00380026OtherRAILROAD MEDICARE
FL'003669200Medicaid
OH2659172Medicaid
OH4181913Medicare PIN
OHI52370Medicare UPIN
FL'003669200Medicaid