Basic Information
| Provider Information | |||||||||
| NPI: | 1659776987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATESA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 ST. PAUL PLACE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106592802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 ST. PAUL PLACE | ||||||||
| Address2: | LOBBY LEVEL | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105392227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 10/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | C05608 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.