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Organization
MD MATT LLC
Active
Organization
MD MATT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CORY SHAFFER (CARE COORDINATOR)
(443) 559-4137
Entity
Organization
Contact information
Practice address
10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
(443) 559-4137
Mailing address
10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
(443) 559-4137
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
06/24/2024
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