Provider Demographics
NPI:1013966100
Name:MATZ, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:5430 CAMPBELL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5503
Mailing Address - Country:US
Mailing Address - Phone:410-933-9404
Mailing Address - Fax:410-933-9405
Practice Address - Street 1:5430 CAMPBELL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5503
Practice Address - Country:US
Practice Address - Phone:410-933-9404
Practice Address - Fax:410-933-9405
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043318207KA0200X
MDD43318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD123991100Medicaid
MDF370028Medicare UPIN
MD189LOtherMEDICARE GROUP