Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 36002679 | OH |
NPI | 1295842334 |
---|---|
Provider Name | Dr. Anthony A. Matalavage |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0979008 | (05) | OH |
U32609 | (02) |