Provider Demographics
NPI:1912215112
Name:VOLTZ, MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:VOLTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-633-3555
Mailing Address - Fax:302-633-3350
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:STE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-633-3555
Practice Address - Fax:302-633-3350
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015269207Q00000X
DEC2-0010185207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2539927OtherCOVENTRY
DE4723016OtherAETNA
P01267911OtherRR MEDICARE
DE1912215112Medicaid
P01267911OtherRR MEDICARE