Healthcare Provider Details

I. General information

NPI: 1922927862
Provider Name (Legal Business Name): ABUDUL W MATOVU FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 FOSTER ST
LITTLETON MA
01460-2018
US

IV. Provider business mailing address

849 BOSTON POST RD E APT 8D
MARLBOROUGH MA
01752-3756
US

V. Phone/Fax

Practice location:
  • Phone: 978-486-3512
  • Fax:
Mailing address:
  • Phone: 978-486-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2386731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: