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General NPI Number Information
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NPI Number | 1861579898
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Entity Type | Individual
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Provider Name | KIMBERLY ANN MATZIE MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 2710 PROSPERITY AVE SUITE 200
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City | FAIRFAX
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State | VA
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Zip | 22031-4357
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Country | US
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Telephone | 703-280-2841
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Fax | 703-280-4773
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Provider Business Mailing Address
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Address Line | 2710 PROSPERITY AVE SUITE 200
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City | FAIRFAX
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State | VA
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Zip | 22031-4357
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Country | US
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Telephone | 703-280-2841
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Fax | 703-280-4773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 0101248220
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 224443
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License Number State | MA
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