Provider Demographics
NPI:1629036538
Name:HILBURN, MATTHEW ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:HILBURN
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 1:2002 MEDICAL PKY
Mailing Address - Street 2:STE 230
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-3900
Mailing Address - Fax:410-266-9245
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:STE 230
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-3900
Practice Address - Fax:410-266-9245
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066415207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD870LS97Medicare PIN
IN079890IMedicare ID - Type Unspecified