Provider Demographics
NPI:1619273737
Name:ARIYAVATKUL, MATTHEW T (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:ARIYAVATKUL
Suffix:
Gender:M
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TURNPIKE, SUITE E
Mailing Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-598-0700
Mailing Address - Fax:877-345-6922
Practice Address - Street 1:1579 STRAITS TURNPIKE, SUITE E
Practice Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:877-345-6922
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002539363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400041817Medicare PIN
CTC01925Medicare PIN