Provider Demographics
NPI:1467519173
Name:MATARAZZO, JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MATARAZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:MATARAZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 27542
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-0542
Mailing Address - Country:US
Mailing Address - Phone:303-233-4671
Mailing Address - Fax:303-237-8458
Practice Address - Street 1:1214 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80232-8022
Practice Address - Country:US
Practice Address - Phone:303-233-4671
Practice Address - Fax:303-237-8458
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D23739Medicare UPIN
COC6502Medicare PIN