MEDICARE: JOEL W MATCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101040957	VA
2	207V00000X	Obstetrics & Gynecology Physician	MD12475	DC
3	208D00000X	General Practice Physician	0101040957	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831185354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL W MATCH MD

Provider Business Mailing Address
First Line	:	6288B ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2801
Country	:	US
Telephone Number	:	703-229-0660
Fax Number	:	703-237-0675

Provider Business Practice Location Address
First Line	:	6288B ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2801
Country	:	US
Telephone Number	:	703-229-0660
Fax Number	:	703-237-0675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/19/2013

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