1093927113 NPI number — DR. MATTHEW SALVATORE PUGLIESE M.D.

Table of content: DR. MATTHEW SALVATORE PUGLIESE M.D. (NPI 1093927113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093927113 NPI number — DR. MATTHEW SALVATORE PUGLIESE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUGLIESE
Provider First Name:
MATTHEW
Provider Middle Name:
SALVATORE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093927113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 BROADWAY
Provider Second Line Business Mailing Address:
DEPARTMENT OF SURGICAL EDUCATION, 7 WEST
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-386-2123
Provider Business Mailing Address Fax Number:
206-386-6293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 ST SEBASTIAN WAY
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-434-0130
Provider Business Practice Location Address Fax Number:
706-434-0131
Provider Enumeration Date:
05/03/2007

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: 2086X0206X , with the licence number:  062417 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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