Provider Demographics
NPI:1487621009
Name:MATARAGAS, NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MATARAGAS
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 1:2001 W SAMPLE ROAD
Mailing Address - Street 2:SUITE 322
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1342
Mailing Address - Country:US
Mailing Address - Phone:954-481-9942
Mailing Address - Fax:954-481-9917
Practice Address - Street 1:2001 W SAMPLE ROAD
Practice Address - Street 2:SUITE 322
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1342
Practice Address - Country:US
Practice Address - Phone:954-481-9942
Practice Address - Fax:954-481-9917
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137362207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109487Medicaid