Basic Information
| Provider Information | |||||||||
| NPI: | 1093927113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUGLIESE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | SALVATORE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 BROADWAY | ||||||||
| Address2: | DEPARTMENT OF SURGICAL EDUCATION, 7 WEST | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063862123 | ||||||||
| FaxNumber: | 2063866293 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 ST SEBASTIAN WAY | ||||||||
| Address2: | STE 104 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064340130 | ||||||||
| FaxNumber: | 7064340131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 12/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 062417 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.