Healthcare Provider Details

I. General information

NPI: 1770544751
Provider Name (Legal Business Name): SUSAN E SHAWVER-MATTHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST
WESTBOROUGH MA
01581-1417
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-898-2338
  • Fax: 508-366-9938
Mailing address:
  • Phone: 508-898-2338
  • Fax: 508-366-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48564
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: