Provider Demographics
NPI:1275380354
Name:MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Entity Type:Organization
Organization Name:MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-220-0720
Mailing Address - Street 1:40 S DUNDALK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4273
Mailing Address - Country:US
Mailing Address - Phone:410-220-0720
Mailing Address - Fax:410-862-0150
Practice Address - Street 1:659 S SALISBURY BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5473
Practice Address - Country:US
Practice Address - Phone:410-220-0720
Practice Address - Fax:410-862-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty