Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ETL6008 | MA |
N | 207XS0106X | Orthopaedic Hand Surgeon | ETL6008 | MA |
NPI | 1306265343 |
---|---|
Provider Name | Matthew Dewolf |
First Address | Pittsfield, MA 01201-0900 |
Second Address | Pittsfield, MA 01201-0900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 17/08/2020 |