Owen Rudolph Mathieu, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

36892 Issued in MA

Practice address

100 Highland Ave
Suite 202
Salem, MA 01970-2702

Phone

(978) 740-0634

Fax

(978) 740-0636

NPI assigned

Dec 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Owen R. Mathieu, Jr., M.D., P.C.

  • Specialist
  • Salem, MA
  • NPI 1669686283
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881750982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE",
            "address_2": "SUITE 202",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019702702",
            "telephone_number": "978-740-0634",
            "fax_number": "978-740-0636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE",
            "address_2": "SUITE 202",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019702702",
            "telephone_number": "978-740-0634",
            "fax_number": "978-740-0636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIEU",
        "first_name": "OWEN",
        "middle_name": "RUDOLPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "36892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2027496",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ahmad Mashlah
• Denise G Mason II
• Holly Mason, M.D.,PH.D.
• Mass Bay Dental PC
• Mass General Brigham Medical Group Northern Massachusetts Inc
• Adam Matos, DO
• Anthony R Mattia, M.D.
• Kendall Loraine Harer Mault, OD
• Lindsay Rebecca Maxwell, M.A.
• Caitlin Jewell Mazzarella, MSW

• Pediatrics Physician in Salem, MA
• Providers in Salem, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.