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NPI Code Detail

MEDICARE: ANTHONY MATTIELLO PA

MEDICARE: ANTHONY MATTIELLO PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1215542360
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY MATTIELLO PA
Provider Business Mailing Address
First Line : 55 PASTURE VIEW LN
Second Line :
City : CRANSTON
State : RI
Zip : 02921-2732
Country : US
Telephone Number : 401-439-6237
Fax Number :
Provider Business Practice Location Address
First Line : 174 ARMISTICE BLVD
Second Line :
City : PAWTUCKET
State : RI
Zip : 02860-3280
Country : US
Telephone Number : 401-753-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2020
Last Update Date : 09/14/2020

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Directions to “ ANTHONY MATTIELLO PA” Practice Location

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