Provider Demographics
NPI:1669496360
Name:SWARTZ, MATTHEW OWEN (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OWEN
Last Name:SWARTZ
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 1:9378 C FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-369-7110
Mailing Address - Fax:703-369-6476
Practice Address - Street 1:9378 FORESTWOOD LN STE C
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4742
Practice Address - Country:US
Practice Address - Phone:703-369-7110
Practice Address - Fax:703-369-6476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035613207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA604542-1Medicaid