Healthcare Provider Details

I. General information

NPI: 1023002045
Provider Name (Legal Business Name): MICHAEL F MASTROMATTEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL MASTROMATTEO

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

BMCHS PROVIDER ENROLLMENT 960 MASSACHUSETTS AVE FLR 2
BOSTON MA
02118-0211
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME153139
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number210267
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: