MEDICARE: DR. MATTHEW J. TROVATO M.D.

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	208200000X	Plastic Surgery Physician	25MA08130400	NJ
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A97314	CA
3	208200000X	Plastic Surgery Physician	N6725	TX

General Provider Information

NPI Number	:	1528157617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J. TROVATO M.D.

Provider Business Mailing Address
First Line	:	16633 DALLAS PKWY
Second Line	:	SUITE 350
City	:	ADDISON
State	:	TX
Zip	:	75001-6816
Country	:	US
Telephone Number	:	214-542-0973
Fax Number	:	214-206-9098

Provider Business Practice Location Address
First Line	:	16633 DALLAS PKWY
Second Line	:	SUITE 350
City	:	ADDISON
State	:	TX
Zip	:	75001-6816
Country	:	US
Telephone Number	:	214-542-0973
Fax Number	:	214-206-9098

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/11/2016

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