Mathisen, Douglas James

Mathisen, Douglas James is an individual health care provider with primary practice located at 55 Fruit Street Blk 1570 Thoracic Surgery Department, Boston MA 02114-2696. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Mathisen, Douglas James can be contacted via phone (617) 726-6826.

Contact Information

Primary practice address
55 Fruit Street Blk 1570 Thoracic Surgery Department Boston MA 02114-2696
Phone: (617) 726-6826
Fax: (617) 726-7667
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 39784 Massachusetts

Profile Details

NPI number 1699759019
LBN Legal business name Mathisen, Douglas James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2005
Last updated Nov 21st, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699759019 NPPES
Massachusetts MEDICAID 0182656
Massachusetts Other 710067
Massachusetts Other E05949

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