Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 274784 | NY |
NPI | 1013274208 |
---|---|
Provider Name | Dr. Matthew James Kratochvil |
First Address | New Bedford, MA 02746-2443 |
Second Address | Buffalo, NY 14202-2211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 06/02/2018 |