Provider Demographics
NPI:1447494885
Name:TAERRI, MATTEO (MD)
Entity type:Individual
Prefix:DR
First Name:MATTEO
Middle Name:
Last Name:TAERRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HOWARD CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5050
Mailing Address - Country:US
Mailing Address - Phone:352-474-9680
Mailing Address - Fax:
Practice Address - Street 1:510 HOWARD CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5050
Practice Address - Country:US
Practice Address - Phone:352-474-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61005207NS0135X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology