Provider Demographics
NPI:1114150935
Name:MATIAS-GOMES, SUSANNE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:MARIE
Last Name:MATIAS-GOMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:508-676-3411
Mailing Address - Fax:508-235-6265
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 2002
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-235-6265
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT158723685207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology