Provider Demographics
NPI:1972818227
Name:BATTAGLIA, MATTHEW E
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:BATTAGLIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:BATTAGLIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:435 FIRESIDE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1303
Mailing Address - Country:US
Mailing Address - Phone:720-480-9709
Mailing Address - Fax:303-449-0634
Practice Address - Street 1:435 FIRESIDE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1303
Practice Address - Country:US
Practice Address - Phone:720-480-9709
Practice Address - Fax:303-449-0634
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3057363A00000X
COPA.0003057363A00000X
WAPA60840325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95072586Medicaid
COCOA109075Medicare PIN