Provider Demographics
NPI:1669419016
Name:MATAS, NICHOLAS STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:MATAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:46 NORTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3845
Mailing Address - Country:US
Mailing Address - Phone:508-778-4888
Mailing Address - Fax:508-778-4887
Practice Address - Street 1:46 NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3845
Practice Address - Country:US
Practice Address - Phone:508-778-4888
Practice Address - Fax:508-778-4887
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79688207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1669419016OtherUNICARE
MA1669419016OtherMEDICARE ID- TYPE UNSPECIFIED
MA1669419016OtherGREAT WEST HEALTHCARE