Provider Demographics
NPI:1659533073
Name:NELSON J MATOS, D.O., P.L.L.C.
Entity Type:Organization
Organization Name:NELSON J MATOS, D.O., P.L.L.C.
Other - Org Name:FAMILY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-794-8119
Mailing Address - Street 1:50 PROSPECT ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2841
Mailing Address - Country:US
Mailing Address - Phone:978-794-8119
Mailing Address - Fax:978-794-9912
Practice Address - Street 1:50 PROSPECT ST
Practice Address - Street 2:SUITE 505
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2841
Practice Address - Country:US
Practice Address - Phone:978-794-8119
Practice Address - Fax:978-794-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0121240Medicaid
MA0121240Medicaid