Provider Demographics
NPI:1275502916
Name:MATSON, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:MATSON
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:EAST GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06025-0010
Mailing Address - Country:US
Mailing Address - Phone:860-430-5773
Mailing Address - Fax:888-285-0925
Practice Address - Street 1:2800 TAMARACK RD
Practice Address - Street 2:SIUTE 108
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-5539
Practice Address - Country:US
Practice Address - Phone:800-588-9240
Practice Address - Fax:888-285-0925
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040285208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3906119OtherOXFORD
CT7190376OtherAETNA
CT3V1999OtherHEALTHNET
CT8711289OtherCIGNA
CT010040285CT06OtherANTHEM
CT040285OtherCONNECTICARE
CT001402859Medicaid
CT2253948OtherUNITED HEALTHCARE
CT2253948OtherUNITED HEALTHCARE