Healthcare Provider Details

I. General information

NPI: 1760185094
Provider Name (Legal Business Name): MATTHEW ALLAN SKRENTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH0106940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: