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Organization

MD MATT LLC

Active
Parent organization
MD MATT LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
MD MATT LLC
Authorized official
WILLIAM SHAFFER (DIRECTOR)
(443) 220-6122
Entity
Organization

Contact information

Practice address
6401 NEW HAMPSHIRE AVE, HYATTSVILLE, MD 20783-3201
(410) 364-8194
(410) 364-8194
Mailing address
10220 S DOLFIELD RD STE 106, OWINGS MILLS, MD 21117-3660
(443) 559-4137

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
363LA2200X
Adult Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
062712289
DC
05
181014604
MD
Enumeration date
09/24/2021
Last updated
12/30/2024
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