Provider Demographics
NPI:1801059894
Name:ERCOLANI, MATTHEW CORBYONS (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CORBYONS
Last Name:ERCOLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:401 COMMERCIAL CT STE E
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1652
Practice Address - Country:US
Practice Address - Phone:941-260-4440
Practice Address - Fax:941-260-4441
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08338400208800000X
FLME107060208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL344433OtherAVMED
FL14A1YOtherBCBS FL
FLP986609OtherFREEDOM HEALTH
FL8962967OtherCIGNA
FL1193012OtherWELLCARE
FLP931608OtherOPTIMUM
FLEP988XOtherMEDICARE (ARCADIA OFFICE)
FLP00924559OtherRAILROAD MEDICARE
FL9592610OtherAETNA
FL8962967OtherCIGNA
FL344433OtherAVMED