Provider Demographics
NPI:1659908234
Name:MATTSON, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:MATTSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 NICOLLS ROAD
Mailing Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY322654-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program