Individual
MR. THOMAS OLIVER MATELLA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-8151
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-8151
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001190430
VA
163W00000X
Registered Nurse
813161
CA
163W00000X
Registered Nurse
R251612
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
0024190240
VA
367500000X
Certified Registered Nurse Anesthetist
813161
CA
367500000X
Certified Registered Nurse Anesthetist
R251612
MD
Other
Enumeration date
02/10/2014
Last updated
07/08/2024
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