1477545507 NPI number — DR. MARGARET BARNES MATARESE M.D.

Table of content: DR. MARGARET BARNES MATARESE M.D. (NPI 1477545507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477545507 NPI number — DR. MARGARET BARNES MATARESE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATARESE
Provider First Name:
MARGARET
Provider Middle Name:
BARNES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARNES-RIVERA
Provider Other First Name:
MARGARET
Provider Other Middle Name:
LUCILLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477545507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2403 PIMPERNEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20603-4944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLLING AFB
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-404-1466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G65554 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083A0100X , with the licence number: G65554 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083X0100X , with the licence number: G65554 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)