Healthcare Provider Details

I. General information

NPI: 1386974467
Provider Name (Legal Business Name): BENJAMIN L MATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJAMIN L MATSON M.D.

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 BIG TREE RD SUITE 108
BUFFALO NY
14127-2291
US

IV. Provider business mailing address

5959 BIG TREE RD STE 108
ORCHARD PARK NY
14127-2291
US

V. Phone/Fax

Practice location:
  • Phone: 716-810-7997
  • Fax: 716-242-0249
Mailing address:
  • Phone: 716-810-7997
  • Fax: 716-242-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number282400
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number282400
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number282400
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number282400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: