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NPI Code Detail

MEDICARE: CAROLINE NEREIRDA MATA MA

MEDICARE: CAROLINE NEREIRDA MATA MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1013435106
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE NEREIRDA MATA MA
Provider Business Mailing Address
First Line : 3 EASTPORT CT
Second Line :
City : LUTHERVILLE
State : MD
Zip : 21093-3803
Country : US
Telephone Number : 410-967-3741
Fax Number :
Provider Business Practice Location Address
First Line : 13313 OLD COLUMBIA PIKE
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-5233
Country : US
Telephone Number : 443-923-4170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2017
Last Update Date : 09/08/2017

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Directions to “ CAROLINE NEREIRDA MATA MA” Practice Location

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