MEDICARE: MRS. MICHELLE MARIE MATARESE PA-C

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
1	363A00000X	Physician Assistant	2930	SC
2	363AS0400X	Surgical Physician Assistant	0010-01206	NC
3	363A00000X	Physician Assistant	1463	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316044266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MARIE MATARESE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-5100
Fax Number	:	704-316-5101

Provider Business Practice Location Address
First Line	:	197 PIEDMONT BLVD STE 100
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1825
Country	:	US
Telephone Number	:	803-324-1950
Fax Number	:	803-324-1933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/21/2025

Similar Medicare Providers

1538016548 — ZIPPORAH THOMPSON
Practice Location Address:

197 PIEDMONT BLVD STE 111
ROCK HILL, SC
29732-1825

Practice Phone: 803-335-0718
Practice Fax:

1891642500 — ZYCURRA WHITE RBT
Practice Location Address:

197 PIEDMONT BLVD STE 111
ROCK HILL, SC
29732-1825

Practice Phone: 803-335-0718
Practice Fax:

1710834445 — DIAMOND WILLIAMS
Practice Location Address:

197 PIEDMONT BLVD STE 111
ROCK HILL, SC
29732-1825

Practice Phone: 803-335-0718
Practice Fax:

1568633824 — SANDI KAY CANDELLA P.A.
Practice Location Address:

197 PIEDMONT BLVD STE 100
ROCK HILL, SC
29732-1825

Practice Phone: 803-324-1950
Practice Fax: 803-324-1933

1508189184 — JENNIFER GAINER PA-C
Practice Location Address:

197 PIEDMONT BLVD STE 100
ROCK HILL, SC
29732-1825

Practice Phone: 803-324-1950
Practice Fax: 803-324-1933

1356653083 — MS. CARLA MARIE T. GO PT
Practice Location Address:

197 PIEDMONT BLVD STE 111
ROCK HILL, SC
29732-1825

Practice Phone: 704-323-2000
Practice Fax:

Directions to “ MRS. MICHELLE MARIE MATARESE PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.