Provider Demographics
NPI:1114470382
Name:MATARRESE, VIRGINIA A (PA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:MATARRESE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40010
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0010
Mailing Address - Country:US
Mailing Address - Phone:251-434-3505
Mailing Address - Fax:251-434-3564
Practice Address - Street 1:HUNTSVILLE HOSPITAL FOR WOMEN & CHILDREN
Practice Address - Street 2:245 GOVERNORS DR. SE
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-2700
Practice Address - Country:US
Practice Address - Phone:256-265-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant