Provider Demographics
NPI:1861911539
Name:MATINKO, PATRICK J (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:MATINKO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:565 COAL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:412-469-5000
Mailing Address - Fax:412-469-7174
Practice Address - Street 1:565 COAL VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-3703
Practice Address - Country:US
Practice Address - Phone:412-469-5100
Practice Address - Fax:412-831-5663
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN601308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN601308OtherRN LICENSE