Provider Demographics
NPI:1467585406
Name:STEPHEN R MATZ MD PA
Entity Type:Organization
Organization Name:STEPHEN R MATZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:MATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-653-3960
Mailing Address - Street 1:2 RESERVOIR CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-653-3960
Mailing Address - Fax:410-653-0807
Practice Address - Street 1:2 RESERVOIR CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-3960
Practice Address - Fax:410-653-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76763Medicare UPIN
6240Medicare ID - Type Unspecified