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General NPI Number Information
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NPI Number | 1629969332
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Entity Type | Organization
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Legal Business Name | SECOND MOUNTAIN INTERNAL MEDICINE P.C.
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 758 BUCKFIELD RD
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City | HEBRON
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State | ME
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Zip | 04238-3261
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Country | US
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Telephone | 860-305-3438
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Fax |
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Provider Business Mailing Address
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Address Line | 758 BUCKFIELD RD
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City | HEBRON
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State | ME
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Zip | 04238-3261
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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 | PHYSICIAN OWNER
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Name | DR. JOHN CHARLES MATULIS III
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Credential | DO, MPH
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Telephone | 860-305-3438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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