Provider Demographics
NPI:1912030958
Name:MATZ, STEPHEN RONALD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RONALD
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 1:2 RESERVOIR CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-653-3960
Mailing Address - Fax:410-653-0807
Practice Address - Street 1:2 RESERVOIR CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-653-3960
Practice Address - Fax:410-653-0807
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18066207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D76763Medicare UPIN
6240Medicare ID - Type Unspecified