Provider Demographics
NPI:1417069204
Name:MATTINGLY, ANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 692
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8692
Mailing Address - Country:US
Mailing Address - Phone:585-275-4861
Mailing Address - Fax:585-273-1114
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 692
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8692
Practice Address - Country:US
Practice Address - Phone:585-275-4861
Practice Address - Fax:585-273-1114
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY244044208M00000X, 207RC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB8135Medicare PIN