Individual
DR. DOUGLAS JAMES MATHISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT STREET, BLK 1570 THORACIC SURGERY DEPARTMENT, BOSTON, MA 02114-2696
(617) 726-6826
(617) 726-7667
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(671) 726-6826
(617) 726-7667
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
39784
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0182656
—
MA
01
—
710067
TUFTS HEALTH PLAN
MA
01
—
E05949
BCBS MA
MA
Enumeration date
11/30/2005
Last updated
11/21/2012
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