Provider Demographics
NPI:1811205990
Name:RALPH A. DEMATTEIS MD PL
Entity Type:Organization
Organization Name:RALPH A. DEMATTEIS MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMATTEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-527-8354
Mailing Address - Street 1:1900 72ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4716
Mailing Address - Country:US
Mailing Address - Phone:727-527-8354
Mailing Address - Fax:
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:SUITE 240
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-322-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021255208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD56288Medicare UPIN