Provider Demographics
NPI:1083204424
Name:MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Entity Type:Organization
Organization Name:MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-220-0720
Mailing Address - Street 1:PO BOX 9068
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-0768
Mailing Address - Country:US
Mailing Address - Phone:410-220-0720
Mailing Address - Fax:410-862-0150
Practice Address - Street 1:253 LEWIS LN STE 201
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3756
Practice Address - Country:US
Practice Address - Phone:410-220-0720
Practice Address - Fax:410-862-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)