Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH 1698 | MA |
NPI | 1023086097 |
---|---|
Provider Name | Dr. Gene E Dematteo |
First Address | Beverly, MA 01915-0001 |
Second Address | Beverly, MA 01915-1139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 07/12/2011 |