Provider Demographics
NPI:1891897757
Name:FICKIE, MATTHEW R (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:FICKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 WAVERLEY OAKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8474
Mailing Address - Country:US
Mailing Address - Phone:781-647-6920
Mailing Address - Fax:781-891-0056
Practice Address - Street 1:355 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8474
Practice Address - Country:US
Practice Address - Phone:781-647-6920
Practice Address - Fax:781-891-0056
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA231500208000000X, 207SG0201X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)