Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 0101258344 | VA |
N | 213ES0000X | Sports Medicine | 0101258344 | VA |
Y | 2081S0010X | Sports Medicine | MD043451 | DC |
Y | 213ES0000X | Sports Medicine | MD043451 | DC |
NPI | 1558592618 |
---|---|
Provider Name | Matthew Maxwell |
First Address | Washington, DC 20010-2921 |
Second Address | Washington, DC 20010-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 02/11/2015 |