Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 37168 | AZ |
NPI | 1003009416 |
---|---|
Provider Name | Matthew Barcellona |
First Address | Scottsdale, AZ 85258-4535 |
Second Address | Scottsdale, AZ 85258-4535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |