Healthcare Provider Details

I. General information

NPI: 1447215470
Provider Name (Legal Business Name): MICHAELA KUNZ MATHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST SUITE 470
BALTIMORE MD
21201-1734
US

IV. Provider business mailing address

805 SCARLETT DR
BALTIMORE MD
21286-2910
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5929
  • Fax: 410-328-6503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0061553
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: