Provider Demographics
NPI:1710298195
Name:MATTHEWS, BRETT JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JOSEPH
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DO
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 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3873
Practice Address - Country:US
Practice Address - Phone:978-572-1149
Practice Address - Fax:978-465-4069
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245414208600000X
HIDOSR 293208600000X
MA266410208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110115794AMedicaid
MAS400327735Medicare PIN