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NPI Code Detail

MEDICARE: MATTHEW CHAMPEAU PA

MEDICARE: MATTHEW CHAMPEAU PA
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
1363A00000XPhysician Assistant001690CT

General Provider Information

NPI Number : 1689654659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW CHAMPEAU PA
Provider Business Mailing Address
First Line : PO BOX 2699
Second Line : DEPT 200
City : HARTFORD
State : CT
Zip : 06146-2699
Country : US
Telephone Number : 866-898-7138
Fax Number : 616-975-9824
Provider Business Practice Location Address
First Line : 41 BREWSTER RD
Second Line :
City : BRISTOL
State : CT
Zip : 06010-5161
Country : US
Telephone Number : 860-585-3000
Fax Number : 860-585-3907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 11/16/2007

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Directions to “ MATTHEW CHAMPEAU PA” Practice Location

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