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
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135675502
—
MD
Enumeration date
03/22/2019
Last updated
05/11/2022
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