Healthcare Provider Details

I. General information

NPI: 1871419937
Provider Name (Legal Business Name): PROTO360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

419 4TH ST
ANNAPOLIS MD
21403-2585
US

IV. Provider business mailing address

419 4TH ST
ANNAPOLIS MD
21403-2585
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-8243
  • Fax:
Mailing address:
  • Phone: 410-823-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATRINA MATTINGLY
Title or Position: FOUNDING PARTNER
Credential: MD
Phone: 410-823-8243