Healthcare Provider Details

I. General information

NPI: 1053308908
Provider Name (Legal Business Name): DAVID E MATTESON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

920 ELKRIDGE LANDING RD
LINTHICUM MD
21090-2917
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax: 443-481-1360
Mailing address:
  • Phone: 443-462-5010
  • Fax: 410-684-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0035235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: