Provider Demographics
NPI:1669686283
Name:OWEN R. MATHIEU, JR., M.D., P.C.
Entity Type:Organization
Organization Name:OWEN R. MATHIEU, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-740-0634
Mailing Address - Street 1:100 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-740-0634
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-740-0634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9703756Medicaid
MAF32016Medicare UPIN