Provider Demographics
NPI:1831185354
Name:MATCH, JOEL W (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:W
Last Name:MATCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6288B ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2801
Mailing Address - Country:US
Mailing Address - Phone:703-229-0660
Mailing Address - Fax:703-237-0675
Practice Address - Street 1:6288B ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2801
Practice Address - Country:US
Practice Address - Phone:703-229-0660
Practice Address - Fax:703-237-0675
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040957207V00000X, 208D00000X
DCMD12475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0404790Medicaid
VA6202136Medicaid
DC0404790Medicaid
VA6202136Medicaid