Healthcare Provider Details

I. General information

NPI: 1972765550
Provider Name (Legal Business Name): JENNIFER M MATRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 JOSEPH SIEWICK DR STE 403
FAIRFAX VA
22033-1764
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-4395
  • Fax: 703-391-4394
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101283867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: