Healthcare Provider Details

I. General information

NPI: 1225016355
Provider Name (Legal Business Name): STEPHEN LAWRENCE MATARESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD SUITE 301
WARWICK RI
02886-4458
US

IV. Provider business mailing address

215 TOLL GATE RD SUITE 301
WARWICK RI
02886-4458
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-1508
  • Fax: 401-732-1592
Mailing address:
  • Phone: 401-732-1508
  • Fax: 401-732-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0355
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0355
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0355
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: