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General NPI Number Information
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NPI Number | 1740690080
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Entity Type | Individual
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Provider Name | MATTHEW BRIAN MACKWOOD MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 18 OLD ETNA RD
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City | LEBANON
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State | NH
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Zip | 03766
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Country | US
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Telephone | 603-650-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 18 OLD ETNA RD
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City | LEBANON
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State | NH
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Zip | 03766-1937
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60672828
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19200
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License Number State | NH
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