Provider Demographics
NPI:1467440735
Name:ANDERSON, MATTHEW PETER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 AVENUE LOUIS PASTEUR
Mailing Address - Street 2:HIM 846
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5727
Mailing Address - Country:US
Mailing Address - Phone:617-667-0853
Mailing Address - Fax:617-667-0810
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DEPT. OF NEUROLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3090
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153393207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA153393OtherSTATE LICENSE
MA3173623Medicaid
MA3173623Medicaid
MAA22934Medicare ID - Type Unspecified