# MD MATT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619583200
- **Authorized official:** WILLIAM SHAFFER (OWNER)
- **Authorized official phone:** (443) 220-6122

## Contact information

- **Practice address:** 309 E PATRICK ST, FREDERICK, MD 21701-6792
- **Practice address phone:** (240) 292-1088
- **Mailing address:** 10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
- **Mailing address phone:** (443) 559-4137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2020
- **Last updated:** 07/16/2024