Individual
JAMIE ELIZABETH MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1413 MADISON PARK DR FL 2, GLEN BURNIE, MD 21061-5613
(410) 691-3571
Mailing address
1413 MADISON PARK DR, GLEN BURNIE, MD 21061-5613
(410) 691-3571
(410) 691-3591
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C06695
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777033200
—
MD
Enumeration date
08/28/2017
Last updated
04/25/2023
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