Healthcare Provider Details

I. General information

NPI: 1629969332
Provider Name (Legal Business Name): SECOND MOUNTAIN INTERNAL MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 BUCKFIELD RD
HEBRON ME
04238-3261
US

IV. Provider business mailing address

758 BUCKFIELD RD
HEBRON ME
04238-3261
US

V. Phone/Fax

Practice location:
  • Phone: 860-305-3438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CHARLES MATULIS III
Title or Position: PHYSICIAN OWNER
Credential: DO, MPH
Phone: 860-305-3438