Provider Demographics
NPI:1750384665
Name:MATTIONI, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:MATTIONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 N CIVIC CENTER PLZ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6919
Mailing Address - Country:US
Mailing Address - Phone:480-246-3000
Mailing Address - Fax:480-246-3100
Practice Address - Street 1:3225 N CIVIC CENTER PLZ
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6919
Practice Address - Country:US
Practice Address - Phone:480-246-3000
Practice Address - Fax:480-246-3100
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20241174400000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060047024OtherMEDICARE RAILROAD
AZAZ0821440OtherBCBS AZ
AZ065640Medicaid
AZ4400898OtherAETNA
AZAZ0821440OtherBCBS AZ
AZ4400898OtherAETNA