Organization
MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN RECK (MANAGER)
(410) 220-0720
Entity
Organization
Contact information
Practice address
253 LEWIS LN STE 201, HAVRE DE GRACE, MD 21078-3756
(410) 220-0720
(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
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210411011
DEPT OF HEALTH, BEHAVIORAL HEALTH ADMIN
MD
Enumeration date
01/20/2021
Last updated
05/11/2022
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