Provider Demographics
NPI:1457348856
Name:MASTROMATTEO, JAMES FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:MASTROMATTEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:RADIOLOGY, FAULKNER HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7163
Mailing Address - Fax:617-983-7553
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:RADIOLOGY, FAULKNER HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7163
Practice Address - Fax:617-983-7553
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA817812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3147126Medicaid
MA081781OtherTUFTS HEALTH CARE
MAJ25545OtherBLUE CROSS/BLUE SHIELD
G28692Medicare UPIN
MAJ25545OtherBLUE CROSS/BLUE SHIELD