Healthcare Provider Details

I. General information

NPI: 1437137841
Provider Name (Legal Business Name): MATTHEW DAVID SOMMER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/29/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIRK US ARMY HEALTH CLINIC 6455 MACHINE STREET
ABERDEEN PROVING GROUND MD
21005-5131
US

IV. Provider business mailing address

4448 PROSPECT RD
WHITEFORD MD
21160-1304
US

V. Phone/Fax

Practice location:
  • Phone: 410-436-3001
  • Fax: 410-436-8409
Mailing address:
  • Phone: 410-399-0384
  • Fax: 410-783-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR137599
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: