Provider Demographics
NPI:1003876384
Name:DONELAN, MATTHIAS BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHIAS
Middle Name:BERNARD
Last Name:DONELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1655
Mailing Address - Country:US
Mailing Address - Phone:617-244-0990
Mailing Address - Fax:617-969-4044
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462-1655
Practice Address - Country:US
Practice Address - Phone:617-244-0990
Practice Address - Fax:617-969-4044
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36527208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE0502101Medicare PIN
A54263Medicare UPIN
MAE05021Medicare ID - Type Unspecified