Provider Demographics
NPI:1023346756
Name:HEBERT, MATTHEW E (CP CFO)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:E
Last Name:HEBERT
Suffix:
Gender:M
Credentials:CP CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WIGWAM BEACH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-2430
Mailing Address - Country:US
Mailing Address - Phone:508-991-5577
Mailing Address - Fax:
Practice Address - Street 1:203 POPES IS
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7232
Practice Address - Country:US
Practice Address - Phone:508-991-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1528271Medicaid
MA1528271Medicaid