Healthcare Provider Details

I. General information

NPI: 1932029576
Provider Name (Legal Business Name): MATTHEW A CULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 LUERSSEN AVE
BALTIMORE MD
21206-5574
US

IV. Provider business mailing address

4508 LUERSSEN AVE
BALTIMORE MD
21206-5574
US

V. Phone/Fax

Practice location:
  • Phone: 410-246-1508
  • Fax: 443-471-8785
Mailing address:
  • Phone: 410-246-1508
  • Fax: 443-471-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC3535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: