Provider Demographics
NPI:1912029919
Name:MINGRONE, MATTHEW DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DOMINIC
Last Name:MINGRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0687
Mailing Address - Country:US
Mailing Address - Phone:408-374-4370
Mailing Address - Fax:415-926-6390
Practice Address - Street 1:50 POST ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4546
Practice Address - Country:US
Practice Address - Phone:408-374-4370
Practice Address - Fax:415-926-6390
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67205207YX0905X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck