Provider Demographics
NPI:1801844428
Name:MATTIN, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:MATTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WASHINGTON PL
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6706
Mailing Address - Country:US
Mailing Address - Phone:603-663-8060
Mailing Address - Fax:603-663-8066
Practice Address - Street 1:5 WASHINGTON PL
Practice Address - Street 2:SUITE 1A
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6706
Practice Address - Country:US
Practice Address - Phone:603-663-8060
Practice Address - Fax:603-663-8066
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204461Medicaid
NH01YP07467NH02OtherANTHEM
3952838OtherAETNA
710701OtherHARVARD PILGRIM
2155068OtherUNITED HEATHCARE
8366627010OtherCIGNA
8366627010OtherCIGNA
710701OtherHARVARD PILGRIM