Provider Demographics
NPI:1619183753
Name:STERLING PLASTIC & RECONSTRUCTIVE SURGEONS, INC.
Entity Type:Organization
Organization Name:STERLING PLASTIC & RECONSTRUCTIVE SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MATHIESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-918-8800
Mailing Address - Street 1:PO BOX 19596
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4090
Mailing Address - Country:US
Mailing Address - Phone:941-918-8330
Mailing Address - Fax:941-918-8332
Practice Address - Street 1:8800 S TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238
Practice Address - Country:US
Practice Address - Phone:941-918-8330
Practice Address - Fax:941-918-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME128227OtherMEDICAL LICENSE
OH2331631Medicaid
OHST9326091Medicare ID - Type Unspecified