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General NPI Number Information
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NPI Number | 1023002045
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Entity Type | Individual
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Provider Name | MICHAEL F MASTROMATTEO MD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 736 CAMBRIDGE ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2907
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Country | US
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Telephone | 617-789-3000
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Fax |
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Provider Business Mailing Address
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Address Line | BMCHS PROVIDER ENROLLMENT 960 MASSACHUSETTS AVE FLR 2
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City | BOSTON
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State | MA
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Zip | 02118-0211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME153139
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 210267
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License Number State | MA
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