Individual
DR. MARK P DEMATTEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Mailing address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
150129
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3158250
—
MA
01
—
766710
TUFTS
MA
01
—
930100100
RAILROAD MEDICARE
MA
01
—
J17389
BLUE CROSS BLUE SHIELD
MA
Enumeration date
06/20/2006
Last updated
01/07/2021
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