Provider Demographics
NPI:1871716704
Name:MATTIOLI, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:MATTIOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4213 HOPE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5416
Mailing Address - Country:US
Mailing Address - Phone:919-401-8844
Mailing Address - Fax:919-401-8844
Practice Address - Street 1:4213 HOPE VALLEY RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5416
Practice Address - Country:US
Practice Address - Phone:919-401-8844
Practice Address - Fax:919-401-8844
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC95001372084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry