Doctor Name: | CHARLES S MATUSOVICH |
NPI Number: | 1134143514 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | R042849 |
Business Practice Address: | 2 Chabot St Westbrook, ME - 040924817 |
Business Phone Number: | 2078579311 |
Business Fax Number: | 2078579324 |
Mailing Address: | 2 Chabot St, WESTBROOK |
State: | ME |
Postal Code: | 040924817 |
Phone Number: | 2078579311 |
Fax Number: | 2078579324 |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 10/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R042849 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |