Healthcare Provider Details

I. General information

NPI: 1306668645
Provider Name (Legal Business Name): MATTHEW LEE DIMAURO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR STE 309
SPRINGFIELD MA
01107-1271
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-8020
  • Fax: 413-794-2165
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2263329
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: