Provider Demographics
NPI:1053308908
Name:MATTESON, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:MATTESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 ELKRIDGE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2917
Mailing Address - Country:US
Mailing Address - Phone:443-462-5010
Mailing Address - Fax:410-684-2031
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-1360
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145724700OtherFEDERAL WORKMAN'S COMP
MD887BAA 41761203OtherCAREFIRST BCBS
DCK5850002OtherCAREFIRST BCBS
MD1191974OtherAETNA HMO
MD936200201275971300Medicaid
DCK5850002OtherCAREFIRST BCBS
MD936200201275971300Medicaid