Provider Demographics
NPI:1902831951
Name:MATZ, SAMUEL O (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:O
Last Name:MATZ
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:410-871-6502
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-871-0088
Practice Address - Fax:410-871-0083
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026827207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD444261000Medicaid
C46684Medicare UPIN
MD238703YBDBMedicare PIN