Provider Demographics
NPI:1225014418
Name:MATEJKA, JAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:P
Last Name:MATEJKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:690 CANTON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2326
Mailing Address - Country:US
Mailing Address - Phone:339-204-9516
Mailing Address - Fax:781-459-4698
Practice Address - Street 1:690 CANTON ST STE 240
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2326
Practice Address - Country:US
Practice Address - Phone:339-204-9516
Practice Address - Fax:781-459-4698
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77755207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3115640Medicaid
MA3115640Medicaid
MAJ1385501Medicare PIN
F61396Medicare UPIN