Provider Demographics
NPI:1598977985
Name:MATTHEWS, MICHAEL JUDE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:713 PARK AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4714
Mailing Address - Country:US
Mailing Address - Phone:410-878-6564
Mailing Address - Fax:410-878-6513
Practice Address - Street 1:713 PARK AVE
Practice Address - Street 2:APT 1B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4714
Practice Address - Country:US
Practice Address - Phone:410-878-6564
Practice Address - Fax:410-878-6513
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01550224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant