Provider Demographics
NPI:1780117051
Name:MATTIA, ALEX (DPM)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MATTIA
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 1:106 IRVING ST NW STE 402
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2989
Mailing Address - Country:US
Mailing Address - Phone:202-726-1800
Mailing Address - Fax:202-726-9661
Practice Address - Street 1:106 IRVING ST NW STE 402
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2989
Practice Address - Country:US
Practice Address - Phone:202-726-1800
Practice Address - Fax:202-726-9661
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000174213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty