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Individual

RICHARD A MATARESE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
19328 US ROUTE 11, SUITE B, WATERTOWN, NY 13601-5337
(315) 782-0136
(315) 782-7212
Mailing address
19328 US ROUTE 11, SUITE B, WATERTOWN, NY 13601-5337
(315) 782-4207
(315) 782-8699

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
112674
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00273698
NY
Enumeration date
06/07/2006
Last updated
03/12/2008
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