Provider Demographics
NPI:1992028583
Name:CARLSON, MATTHEW J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:575 TURNPIKE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5924
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:978-975-3925
Practice Address - Street 1:323 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4659
Practice Address - Country:US
Practice Address - Phone:978-794-1946
Practice Address - Fax:978-975-3925
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
NH1037363AS0400X
MAPA5055363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer