Healthcare Provider Details

I. General information

NPI: 1700382777
Provider Name (Legal Business Name): SAMANTHA KATE MATUELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW STE 200
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

2115 WISCONSIN AVE NW STE 200
WASHINGTON DC
20007-2265
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax: 202-944-5402
Mailing address:
  • Phone: 202-944-5400
  • Fax: 202-944-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210002321
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: