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Organization
MD MATT LLC
Active
Organization
MD MATT LLC
Active
Parent organization
MD MATT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MD MATT LLC
Authorized official
WILLIAM SHAFFER (DIRECTOR)
(443) 220-6122
Entity
Organization
Contact information
Practice address
6401 NEW HAMPSHIRE AVE, HYATTSVILLE, MD 20783-3201
(410) 364-8194
(410) 364-8194
Mailing address
10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
(443) 559-4137
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062712289
—
DC
05
—
181014604
—
MD
Enumeration date
09/24/2021
Last updated
12/30/2024
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