Provider Demographics
NPI:1922131317
Name:MESSINA, MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MESSINA
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 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 341
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-964-0024
Mailing Address - Fax:617-964-6374
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 341
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-964-0024
Practice Address - Fax:617-964-6374
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216189207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25609OtherBLUE CROSS
MA216189OtherTUFTS
MA0181951Medicaid
MAHARVARD PILGRIMOtherAA54202
MAG94961Medicare UPIN
MAHARVARD PILGRIMOtherAA54202