Provider Demographics
NPI:1689976888
Name:MATARAZZO, MARIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:MATARAZZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 SALTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2252
Mailing Address - Country:US
Mailing Address - Phone:412-795-1170
Mailing Address - Fax:412-795-1154
Practice Address - Street 1:7125 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-2252
Practice Address - Country:US
Practice Address - Phone:412-795-1170
Practice Address - Fax:412-795-1154
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13577211OtherCAQH
PA103273514Medicaid