Healthcare Provider Details

I. General information

NPI: 1538198734
Provider Name (Legal Business Name): MATTHEW BELZAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 KING AVE STE 208
BALTIMORE MD
21237-4003
US

IV. Provider business mailing address

29466 PINTAIL DR STE 8
EASTON MD
21601-9324
US

V. Phone/Fax

Practice location:
  • Phone: 410-294-6323
  • Fax:
Mailing address:
  • Phone: 443-746-2045
  • Fax: 410-819-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024167314
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1002703
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: