Provider Demographics
NPI:1497093215
Name:MATKOVIC, THOMAS VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VINCENT
Last Name:MATKOVIC
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 1:11656 DANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3752
Mailing Address - Country:US
Mailing Address - Phone:301-881-7047
Mailing Address - Fax:
Practice Address - Street 1:11656 DANVILLE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3752
Practice Address - Country:US
Practice Address - Phone:301-881-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO8014102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst