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General NPI Number Information
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NPI Number | 1700204534
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Entity Type | Individual
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Provider Name | MR. MATTHEW BENEDICT CLEMENTS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 41 MALL RD
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City | BURLINGTON
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State | MA
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Zip | 01805-0816
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Country | US
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Telephone | 781-744-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 LEE ST BOX 800719
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-2150
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 292300
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License Number State | MA
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