Basic Information
Provider Information
NPI: 1710276647
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SZARKO
FirstName: MATTHEW
MiddleName: SCOTT
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 327 MEDICAL PARK DR
Address2:  
City: BRIDGEPORT
State: WV
PostalCode: 263309006
CountryCode: US
TelephoneNumber: 6813421000
FaxNumber:  
Practice Location
Address1: 327 MEDICAL PARK DR
Address2:  
City: BRIDGEPORT
State: WV
PostalCode: 263309006
CountryCode: US
TelephoneNumber: 6813421000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2011
LastUpdateDate: 04/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X25419WVY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


Home