Organization
MATRIX HOUSE PHYSICIANS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NADEHZDA KOVALCHUK M.D. (MEDICAL DIRECTOR)
(301) 552-8118
Entity
Organization
Contact information
Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3595
(301) 552-8118
(301) 498-3074
Mailing address
PO BOX 17301, BALTIMORE, MD 21297-1301
(301) 498-2922
(301) 498-3074
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055700500
—
MD
01
—
G479
BCBS GROUP PROVIDER #
DC
01
—
LL77MA
BCBS GROUP PROVIDER #
MD
Enumeration date
05/27/2006
Last updated
11/14/2011
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