Provider Demographics
NPI:1831162155
Name:MATTERN, ERICH VON (MD)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:VON
Last Name:MATTERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 281738
Mailing Address - Street 2:RURAL RTE. 551 RIDGEWAY DRIVE
Mailing Address - City:LAMOILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89828-1738
Mailing Address - Country:US
Mailing Address - Phone:775-778-9633
Mailing Address - Fax:775-778-0304
Practice Address - Street 1:RURAL RTE. 551 RIDGEWAY DRIVE
Practice Address - Street 2:BOX 281738
Practice Address - City:LAMOILLE
Practice Address - State:NV
Practice Address - Zip Code:89828-1738
Practice Address - Country:US
Practice Address - Phone:775-778-9633
Practice Address - Fax:775-778-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV7943207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG32049Medicare UPIN
NVV38116Medicare ID - Type UnspecifiedMEDICARE PART B PROV. #