Provider Demographics
NPI:1033144043
Name:MATTESON, GERALDINE (PA)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:MATTESON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:489 BEARSES WAY
Mailing Address - Street 2:A-4
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2707
Mailing Address - Country:US
Mailing Address - Phone:508-771-4092
Mailing Address - Fax:508-771-4092
Practice Address - Street 1:489 BEARSES WAY
Practice Address - Street 2:A-4
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2707
Practice Address - Country:US
Practice Address - Phone:508-771-4092
Practice Address - Fax:508-771-4092
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P10674Medicare UPIN
MAAP1295Medicare ID - Type Unspecified