Provider Demographics
NPI:1275536963
Name:SPEICHER, MATTHEW ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALFRED
Last Name:SPEICHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 FALLS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2219
Mailing Address - Country:US
Mailing Address - Phone:410-377-7611
Mailing Address - Fax:410-377-8221
Practice Address - Street 1:6115 FALLS RD
Practice Address - Street 2:STE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2219
Practice Address - Country:US
Practice Address - Phone:410-377-7611
Practice Address - Fax:410-377-8221
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057303207W00000X
PAMD421374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01951362Medicaid
3228819OtherAETNA
PA50012554OtherCAPITAL BLUE CORSS
MD61949801OtherCAREIFRST BC/BS
PASP1469598OtherHIGHMARK BLUE SHIELD
3107146OtherALLIANCE
MD187293OtherAMERIGROUP
2895545OtherCIGNA
DCR6160003OtherCAREFIRST BC/BS
PASP1469598OtherKEYSTONE
67192000000OtherPHN
MD919647OtherBLOCK VISION
MDP00030755OtherMEDICARE RAILROAD
PAP00030758OtherMEDICARE RAILROAD
MD0802234OtherAMERICHOICE
PA1534035OtherGATEWAY
MD4019288Medicaid
MD879LG016Medicare ID - Type Unspecified
MD0802234OtherAMERICHOICE
PA01951362Medicaid