Provider Demographics
NPI:1093281446
Name:GOMBERG, MATTHEW LEONARD (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEONARD
Last Name:GOMBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:114 W PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9784
Mailing Address - Country:US
Mailing Address - Phone:413-539-8800
Mailing Address - Fax:
Practice Address - Street 1:100 TER HEUN DRIVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:413-539-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant