Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 11966 | NH |
NPI | 1184677312 |
---|---|
Provider Name | Michael E Matos |
First Address | Wolfeboro, NH 03894-0912 |
Second Address | Wolfeboro, NH 03894 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30203628 | (05) | NH |