Provider Demographics
NPI:1376665380
Name:MATTHEW D. MINGRONE, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MATTHEW D. MINGRONE, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:MINGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-374-4370
Mailing Address - Street 1:555 KNOWLES DR
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1549
Mailing Address - Country:US
Mailing Address - Phone:408-374-4370
Mailing Address - Fax:408-374-8526
Practice Address - Street 1:555 KNOWLES DR
Practice Address - Street 2:SUITE 121
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1549
Practice Address - Country:US
Practice Address - Phone:408-374-4370
Practice Address - Fax:408-374-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA672052082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty