Healthcare Provider Details

I. General information

NPI: 1285040923
Provider Name (Legal Business Name): TAMAR MATITASHVILI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PONDMEADOW DR STE 101
READING MA
01867-3222
US

IV. Provider business mailing address

20 PONDMEADOW DR STE 101
READING MA
01867-3222
US

V. Phone/Fax

Practice location:
  • Phone: 877-877-9901
  • Fax: 781-942-7200
Mailing address:
  • Phone: 877-877-9901
  • Fax: 781-942-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number1024951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: