Provider Demographics
NPI:1043573959
Name:PIAZZA, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 480
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3676
Mailing Address - Country:US
Mailing Address - Phone:703-248-0111
Mailing Address - Fax:703-248-0046
Practice Address - Street 1:1635 N GEORGE MASON DR STE 480
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3676
Practice Address - Country:US
Practice Address - Phone:703-248-0011
Practice Address - Fax:703-248-0046
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA160670207T00000X
PAMT202574207T00000X
VA0101273706207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101273706OtherMEDICAL LICENSE
CAA160670OtherMEDICAL LICENSE