Provider Demographics
NPI:1447571559
Name:STANISHEWSKI, MATTHEW JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:STANISHEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:JOHN
Other - Last Name:STANISHEWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:140 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5018
Mailing Address - Country:US
Mailing Address - Phone:802-440-4293
Mailing Address - Fax:
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:DEPT. OF MEDICINE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4728
Practice Address - Country:US
Practice Address - Phone:401-456-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-13
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013569207R00000X
RIDO00758207R00000X
VT032.0110465207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine