Provider Demographics
NPI:1780092221
Name:RATZ, MATTHEW JASON (MED)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JASON
Last Name:RATZ
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OWENS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2368
Mailing Address - Country:US
Mailing Address - Phone:301-646-6951
Mailing Address - Fax:
Practice Address - Street 1:16 OWENS GLEN CT
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2368
Practice Address - Country:US
Practice Address - Phone:301-646-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-3470251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services