Provider Demographics
NPI:1467476226
Name:BUSH, MATTHEW DONALD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DONALD
Last Name:BUSH
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 BARRA RD STE 103
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9461
Practice Address - Country:US
Practice Address - Phone:207-283-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17164207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2088OtherMEDICARE
100294000OtherUSPS WC
AA67813OtherHARVARD PILGRIM
BU-ME2088OtherCMS PROVIDER IDENTIFICATION NUMBER
128943OtherAETNA
201017OtherASC FACILITY
MM0716OtherCLINIC FACILITY
010416156OtherCORE / MEDNET / TRAVELERS
0378600001OtherDMERC
ME432322499OtherMAINECARE
0526606OtherCIGNA / GREAT WEST
100522OtherANTHEM