Provider Demographics
NPI:1609053552
Name:WYLIE, MATTHEW C (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:WYLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1101
Mailing Address - Country:US
Mailing Address - Phone:508-634-5050
Mailing Address - Fax:508-634-9621
Practice Address - Street 1:101 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1101
Practice Address - Country:US
Practice Address - Phone:508-634-5050
Practice Address - Fax:508-634-9621
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13917208000000X
MA238920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics