Provider Demographics
NPI:1669432894
Name:CERNIGLIA, MATTHEW W (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:CERNIGLIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 TOWNE CT
Mailing Address - Street 2:100
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1279
Mailing Address - Country:US
Mailing Address - Phone:817-847-8500
Mailing Address - Fax:817-847-8522
Practice Address - Street 1:816 TOWNE CT
Practice Address - Street 2:100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1279
Practice Address - Country:US
Practice Address - Phone:817-847-8500
Practice Address - Fax:817-847-8522
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1417213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1239284OtherAETNA ID
TX8V3763OtherBCBS
TX0031NJOtherBCBS
TX5330820001OtherMEDICARE DME ID NUMBER
TX5889659OtherAETNA ID
TX5330820001OtherMEDICARE DME ID NUMBER
TXU71121Medicare UPIN
TX5330820001Medicare NSC
TX8F2184Medicare PIN