National Provider Identifier
Matthew Albert Mavissakalian, D.O.
Matthew Albert Mavissakalian, D.O. is listed in the NPPES registry with a primary specialty of Allergy & Immunology Physician in Tonawanda, NY and a listed phone number of (716) 874-8980.
Profile Overview
- NPI
- 1790028397
- Provider Type
- Individual
- Primary Specialty
- Allergy & Immunology Physician
- Enumeration Date
- April 02, 2013
- Last Updated
- November 05, 2018
Practice Location
- 2540 Sheridan Dr
- Tonawanda, NY 14150-9410
Phone: (716) 874-8980
Mailing Address
- 2157 Main St
- Buffalo, NY 14214-2648
Specialties
- Allergy & Immunology Physician (207K00000X)
Full Record
- NPI
- 1790028397
- Entity Type
- Individual
- Last Name
- Mavissakalian
- First Name
- Matthew
- Middle Name
- Albert
- Name Prefix
- Dr.
- Credential
- D.O.
- Mailing Street Address
- 2157 Main St
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14214-2648
- Mailing Country
- US
- Practice Street Address
- 2540 Sheridan Dr
- Practice City
- Tonawanda
- Practice State
- NY
- Practice ZIP Code
- 14150-9410
- Practice Country
- US
- Practice Phone
- (716) 874-8980
- Enumeration Date
- April 02, 2013
- Last Updated
- November 05, 2018
- Sex
- Male
- Sole Proprietor
- Yes
- Taxonomy Group 1
- 193400000X Single Specialty Group
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Allergy & Immunology Physician (207K00000X)