MATCLINIC PHYSICIANS PRACTICE GROUP LLC NPI 1104375294

NPI Information

NPI: 1104375294
Provider Name: MATCLINIC PHYSICIANS PRACTICE GROUP LLC
Classification: Internal Medicine - 207RA0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
40 S DUNDALK AVE STE 400
DUNDALK, MD
ZIP 21222
Phone: (410) 220-0780
Get Directions

MATCLINIC PHYSICIANS PRACTICE GROUP LLC is an addiction medicine internal medicine in Dundalk, MD. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. MATCLINIC PHYSICIANS PRACTICE GROUP LLC NPI is 1104375294. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

40 S DUNDALK AVE STE 400
DUNDALK, MD
ZIP 21222
Phone: (410) 220-0780
Fax: (410) 862-0150

The provider's authorized official is Daniel Reck .
The authorized official title is Manager and has the following contact phone number (410) 220-0780.

The enumeration date for this NPI number is 9/29/2016 and was last updated on 5/11/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2084A0401X	Psychiatry & Neurology	Addiction Medicine	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
3	101YM0800X	Counselor	Mental Health	No
4	2084P0800X	Psychiatry & Neurology	Psychiatry	No
5	101YP2500X	Counselor	Professional	No
6	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No
7	207RA0401X	Internal Medicine	Addiction Medicine	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	357117300	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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