Provider Demographics
NPI:1558462374
Name:MATHEW, MATHEW BIJOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:BIJOY
Last Name:MATHEW
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 1:422 WORCESTER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5341
Mailing Address - Country:US
Mailing Address - Phone:617-872-4928
Mailing Address - Fax:781-416-7379
Practice Address - Street 1:422 WORCESTER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-5341
Practice Address - Country:US
Practice Address - Phone:617-872-4928
Practice Address - Fax:781-416-7379
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD119902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000041323OtherBLUE CHIP
RI0000031067OtherBLUE CROSS
RI9004668Medicaid
RI9004668Medicaid
RI0000041323OtherBLUE CHIP