Provider Demographics
NPI:1063463313
Name:MATINO, JAMES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:MATINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3207
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-249-8595
Mailing Address - Fax:860-249-0365
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2118
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-241-0870
Practice Address - Fax:860-241-8296
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT019442208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001194422Medicaid
CT001194422Medicaid
C59662Medicare UPIN