Provider Demographics
NPI:1134105646
Name:TIERNEY, MATTHEW J (DO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46 OBERY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2237
Mailing Address - Country:US
Mailing Address - Phone:508-746-6385
Mailing Address - Fax:508-747-6685
Practice Address - Street 1:46 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2237
Practice Address - Country:US
Practice Address - Phone:508-746-6385
Practice Address - Fax:508-747-6685
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27151OtherBCBSMA
MA3657254OtherAETNA/US HEALTHCARE
MAAA15261OtherHARVARD PILGRIM HEALTHCAR
MA2036070Medicaid
MA468752OtherTUFTS HEALTH PLAN
MA1701676OtherUNITED HEALTHCARE
MAA3653701Medicare PIN
MAI02069Medicare UPIN
MAA36537Medicare PIN