Organization
MD MATT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM SHAFFER (DIRECTOR)
(443) 559-4137
Entity
Organization
Contact information
Practice address
518 S CAMP MEADE RD STE 5, LINTHICUM HEIGHTS, MD 21090-2766
(410) 364-8011
Mailing address
10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
(443) 559-4137
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181014602
—
MD
Enumeration date
04/09/2020
Last updated
07/16/2024
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