Provider Demographics
NPI:1447252911
Name:MATZINGER, CAROLYN ANNE (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNE
Last Name:MATZINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 SOUTHERN HIGHLANDS PKWY
Mailing Address - Street 2:SUITE 110-419
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4371
Mailing Address - Country:US
Mailing Address - Phone:702-380-1974
Mailing Address - Fax:702-269-5547
Practice Address - Street 1:10620 SOUTHERN HIGHLANDS PKWY
Practice Address - Street 2:SUITE 110-419
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4371
Practice Address - Country:US
Practice Address - Phone:702-380-1974
Practice Address - Fax:702-269-5547
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10187207R00000X
IDM-10201208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447252911Medicaid
NV1447252911Medicaid
NV100286Medicare PIN
NVE65790Medicare UPIN
NVFA706YMedicare PIN