Individual ProviderKen MatsuoInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address56 Franklin St, Waterbury, CT 06706-1253(203) 709-8820(800) 925-7270PECOS EnrollmentBased on the most recent information from CMS, provider Ken Matsuo is legally eligible to order and refer claims for Part B, HHA and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1053600429Provider TypeIndividualFull NameMatsuo, KenTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date4/6/2011Last Updated8/18/2014Contact InformationPractice LocationPractice Address56 Franklin St, Waterbury, CT 06706-1253Phone(203) 709-8820Fax(203) 709-3679Mailing LocationMailing AddressPO Box 1090, Windsor, CT 06095-6190Phone(800) 925-7270Fax(888) 331-1015Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense53316ConnecticutCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense53316Connecticut