Healthcare Provider Details

I. General information

NPI: 1063934958
Provider Name (Legal Business Name): MATTHEW BARTOLOTTI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 PLEASANT ST
CONCORD NH
03301-7560
US

IV. Provider business mailing address

253 PLEASANT ST
CONCORD NH
03301-7560
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-6100
  • Fax:
Mailing address:
  • Phone: 603-748-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1665
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: