Provider Demographics
NPI:1225016355
Name:MATARESE, STEPHEN LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:MATARESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-732-1508
Mailing Address - Fax:401-732-1592
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-732-1508
Practice Address - Fax:401-732-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI0355207RP1001X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISM02125Medicaid
RISM02125Medicaid