Healthcare Provider Details

I. General information

NPI: 1609973809
Provider Name (Legal Business Name): CAPE COD HAND SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDUSTRIAL DR SUITE 109
MASHPEE MA
02649-3464
US

IV. Provider business mailing address

5 INDUSTRIAL DR SUITE 109
MASHPEE MA
02649-3464
US

V. Phone/Fax

Practice location:
  • Phone: 508-539-6175
  • Fax:
Mailing address:
  • Phone: 508-539-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number222218
License Number StateMA

VIII. Authorized Official

Name: DR. JESSICA ANNE MATTOLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-539-6175