License holder summary

Matthew Provencher is a Board Of Registration In Medicine licensed to practice in Massachusetts. The address on file for Matthew Provencher is MGH / Sports Medicine Service, 175 Cambridge Street / Fl. 4, Boston 02114. This licensed professional license is current. The license was granted 07/17/2013 and expired on 02/21/2018.

Massachusetts

Division of Professional Licensure

Matthew Provencher
Board Of Registration In Medicine
License number
255099
Date granted
07/17/2013
Date expires
02/21/2018
Class
Board Of Registration In Medicine
Status
Active
Address
MGH / Sports Medicine Service, 175 Cambridge Street / Fl. 4
licensingma.org
ID 41468501
LAST UPDATED 2024-02-17 15:04:41 UTC

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