Provider Demographics
NPI:1679554588
Name:SMITH, MATTHEW (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-727-5257
Mailing Address - Fax:617-726-4899
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:HEMATOLOGY ONCOLOGY ASSOCIATES COX 640
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2617
Practice Address - Country:US
Practice Address - Phone:617-724-5257
Practice Address - Fax:617-724-3166
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79707207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30604OtherBCBS MA
MA3150691Medicaid
MA079707OtherTUFTS HEALTH PLAN
MAJ30604Medicare ID - Type Unspecified
MA3150691Medicaid