MEDICARE: MD MATT LLC

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
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578182614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD MATT LLC

Provider Business Mailing Address
First Line	:	10220 S DOLFIELD RD STE 106
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3660
Country	:	US
Telephone Number	:	443-559-4137
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 S CAMP MEADE RD STE 5
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2766
Country	:	US
Telephone Number	:	410-364-8011
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	WILLIAM SHAFFER
Credential	:
Telephone Number	:	443-559-4137

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	07/16/2024

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Directions to “MD MATT LLC ” Practice Location

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