MEDICARE: GERALDINE MATTESON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	638	MA

General Provider Information

NPI Number	:	1033144043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE MATTESON PA

Provider Business Mailing Address
First Line	:	489 BEARSES WAY
Second Line	:	A-4
City	:	HYANNIS
State	:	MA
Zip	:	02601-2707
Country	:	US
Telephone Number	:	508-771-4092
Fax Number	:	508-771-4092

Provider Business Practice Location Address
First Line	:	489 BEARSES WAY
Second Line	:	A-4
City	:	HYANNIS
State	:	MA
Zip	:	02601-2707
Country	:	US
Telephone Number	:	508-771-4092
Fax Number	:	508-771-4092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/08/2015

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