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Organization
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Active
Organization
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN RECK (MANAGER)
(410) 220-0780
Entity
Organization
Contact information
Practice address
107 RIDGELY AVE STE 12, ANNAPOLIS, MD 21401-1417
(410) 220-0780
(410) 862-0150
Mailing address
PO BOX 9068, BALTIMORE, MD 21222-0768
(410) 220-0720
(410) 862-0150
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200710012
DEPT OF HEALTH, BEHAVIORAL HEALTH ADMIN
MD
05
—
661011101
—
MD
Enumeration date
08/07/2020
Last updated
05/11/2022
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