Individual
NICHOLAS MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2950
(844) 940-7246
(833) 909-4296
Mailing address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2950
(844) 940-7246
(833) 909-4296
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
D90988
MD
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
D90988
MD
Other
Enumeration date
04/28/2016
Last updated
03/02/2026
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