Healthcare Provider Details

I. General information

NPI: 1942255823
Provider Name (Legal Business Name): ROBERT JOSEPH MATHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST
WOLFEBORO NH
03894-4411
US

IV. Provider business mailing address

P O BOX 912
WOLFEBORO NH
03894-0912
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7500
  • Fax: 603-515-2031
Mailing address:
  • Phone: 603-569-7500
  • Fax: 603-515-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7792
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number7792
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: