Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | D0043318 | MD |
NPI | 1013966100 |
---|---|
Provider Name | Jonathan Matz |
First Address | White Marsh, MD 21162-5503 |
Second Address | White Marsh, MD 21162-5503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123991100 | (05) | MD |
F370028 | (02) | MD |