Provider Demographics
NPI:1982662763
Name:JENSEN, MATTHEW BARRY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BARRY
Last Name:JENSEN
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 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7529
Mailing Address - Country:US
Mailing Address - Phone:603-224-6691
Mailing Address - Fax:603-227-7569
Practice Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7529
Practice Address - Country:US
Practice Address - Phone:603-224-6691
Practice Address - Fax:603-227-7569
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI509972084N0400X
NH195252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology