Provider Demographics
NPI:1801849096
Name:CLOTT, MATTHEW ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:CLOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOUNTAIN BLVD
Mailing Address - Street 2:BLDG T
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5644
Mailing Address - Country:US
Mailing Address - Phone:908-222-0070
Mailing Address - Fax:908-222-8027
Practice Address - Street 1:31 MOUNTAIN BLVD
Practice Address - Street 2:BLDG T
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5644
Practice Address - Country:US
Practice Address - Phone:908-222-0070
Practice Address - Fax:908-222-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07555400208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMC01512F10OtherEMPIRE BC/BS
NJJ33130OtherHEALTHNET
NJ8219869OtherGHI
NJP00166342OtherUNITED HEALTHCARE RR
NJP3106486OtherOXFORD
NJMC01512F10OtherEMPIRE BC/BS
NJP3106486OtherOXFORD
NJ083610S71Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE