Provider Demographics
NPI:1972599744
Name:MATHEWSON, HERBERT ODELL (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:ODELL
Last Name:MATHEWSON
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 1:2971 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-0614
Mailing Address - Country:US
Mailing Address - Phone:508-362-2889
Mailing Address - Fax:
Practice Address - Street 1:2971 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630
Practice Address - Country:US
Practice Address - Phone:508-362-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD88098Medicare UPIN
MAB31084Medicare PIN