Provider Demographics
NPI:1437847316
Name:WACHTMAN, MATTHEW ADAM
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:WACHTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10174 MAXINE ST
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6317
Mailing Address - Country:US
Mailing Address - Phone:443-955-8227
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW STE 403
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3716
Practice Address - Country:US
Practice Address - Phone:202-721-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program