Provider Demographics
NPI:1801102223
Name:LAPORTA, MATTHEW W (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:LAPORTA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1625 GEORGE MASON DRIVE
Mailing Address - Street 2:MEDICAL OFFICES A, SUITE #344
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-842-4188
Mailing Address - Fax:703-687-9081
Practice Address - Street 1:1625 N GEORGE MASON DR STE 375
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3687
Practice Address - Country:US
Practice Address - Phone:703-842-4188
Practice Address - Fax:703-842-4187
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS018258208600000X
VA0116022565208600000X, 2086S0127X
VA01022041992086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA517365Medicare PIN