Provider Demographics
NPI:1073586608
Name:NORMAN, MATTHEW E (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:NORMAN
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 1:738 ISLINGTON ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7217
Mailing Address - Country:US
Mailing Address - Phone:603-436-7485
Mailing Address - Fax:603-436-6484
Practice Address - Street 1:738 ISLINGTON ST
Practice Address - Street 2:UNIT B
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7217
Practice Address - Country:US
Practice Address - Phone:603-436-7485
Practice Address - Fax:603-436-6484
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE36220Medicare UPIN
NHRE4499Medicare ID - Type Unspecified