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NPI Code Detail

MEDICARE: MR. MARK MASON MATTHIESSEN

MEDICARE: MR. MARK MASON MATTHIESSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255R0406XBlind Rehabilitation Specialist/TechnologistMA

General Provider Information

NPI Number : 1164373676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK MASON MATTHIESSEN
Provider Business Mailing Address
First Line : 377 PLANTATION ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2245
Country : US
Telephone Number : 413-584-4040
Fax Number :
Provider Business Practice Location Address
First Line : 377 PLANTATION ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2245
Country : US
Telephone Number : 413-584-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ MR. MARK MASON MATTHIESSEN ” Practice Location

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