Healthcare Provider Details

I. General information

NPI: 1104816552
Provider Name (Legal Business Name): HECTOR E MATEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE SUITE 210
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-1780
  • Fax: 508-973-0359
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number227160
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: