Healthcare Provider Details

I. General information

NPI: 1184677312
Provider Name (Legal Business Name): MICHAEL E MATOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST MEDICAL ARTS STE C
WOLFEBORO NH
03894
US

IV. Provider business mailing address

P O BOX 912
WOLFEBORO NH
03894-0912
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7620
  • Fax: 603-569-7619
Mailing address:
  • Phone: 603-569-7620
  • Fax: 603-569-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number11966
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: