Provider Demographics
NPI:1760670285
Name:BURTELOW, MATTHEW AARON (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AARON
Last Name:BURTELOW
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 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2367
Mailing Address - Fax:208-381-4762
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-381-2367
Practice Address - Fax:208-381-4762
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88725207ZC0006X, 207ZP0101X
WA60022117207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology