Healthcare Provider Details

I. General information

NPI: 1114129053
Provider Name (Legal Business Name): KATHERINE DIANE MATTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE DIANE SCHAFBUCH

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 6D
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

1180 BEACON ST STE 6D
BROOKLINE MA
02446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-0440
  • Fax: 617-232-8444
Mailing address:
  • Phone: 617-232-0440
  • Fax: 617-232-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number245099
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number245099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: