Provider Demographics
NPI:1376937409
Name:STEPHEN L. MATARESE DO
Entity Type:Organization
Organization Name:STEPHEN L. MATARESE DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MATARESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-732-1591
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-732-1591
Mailing Address - Fax:401-732-1592
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:STE 301
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-732-1591
Practice Address - Fax:401-732-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 0355207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty