Healthcare Provider Details

I. General information

NPI: 1629182399
Provider Name (Legal Business Name): MATTHEW R CAMUSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE SUITE 200
PORTLAND ME
04103-2362
US

IV. Provider business mailing address

335 BRIGHTON AVE STE 200
PORTLAND ME
04102-2362
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8600
  • Fax: 207-662-8668
Mailing address:
  • Phone: 207-662-8600
  • Fax: 207-662-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD17202
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD17202
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: