Provider Demographics
NPI:1043219298
Name:MATSUMOTO, ALAN KEN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:KEN
Last Name:MATSUMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-3132
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 310
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-942-3132
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036867207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
103774OtherFIRST HEALTH
1847871OtherUNITED HEALTHCARE
493058OtherNCPPO
MD090361200Medicaid
21470OtherPRIORITY PARTNERS
7169832OtherMAMSI
0004482962OtherAETNA
397348OtherALLIANCE
DC0009OtherCAREFIRST OF DC
MD52147007OtherCAREFIRST OF MARYLAND
7169832OtherMAMSI
103774OtherFIRST HEALTH
660003592Medicare PIN