Organization
INGERLISA MATTOCH MD INC
Active
Other names
Tiaga Pathology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INGERLISA MATTOCH MD (AUTHORIZED REPRESENTATIVE)
(970) 818-6788
Entity
Organization
Contact information
Practice address
1708 BOISE AVE, LOVELAND, CO 80538-4204
(708) 186-7889
Mailing address
PO BOX 7268, LOVELAND, CO 80537-0268
(970) 663-2742
(970) 667-0847
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
—
—
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
Other
Enumeration date
05/25/2022
Last updated
06/14/2022
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