| Md Matt Llc | |
|
110 Painters Mill Rd Owings Mills MD 21117-4920 | |
| (443) 559-4137 | |
| Not Available |
| Full Name | Md Matt Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 110 Painters Mill Rd, Owings Mills, Maryland |
| Authorized Official Name and Position | William Cory Shaffer (CARE COORDINATOR) |
| Authorized Official Contact | 4435594137 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Md Matt Llc 14 Jonathans Ct Hunt Valley MD 21030-1420 Ph: (443) 559-4137 | Md Matt Llc 110 Painters Mill Rd Owings Mills MD 21117-4920 Ph: (443) 559-4137 |
| NPI Number | 1669941175 |
|---|---|
| Provider Enumeration Date | 11/14/2018 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Medicare PECOS PAC ID | 6800297524 |
|---|---|
| Medicare Enrollment ID | O20210701000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669941175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Primary |
| Provider Name | Natasha T Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740618776 PECOS PAC ID: 4981822681 Enrollment ID: I20140821000873 |
| Provider Name | Chinyere Umezurike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407261654 PECOS PAC ID: 9133497530 Enrollment ID: I20170607001387 |
| Provider Name | Asia K Douglas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518421973 PECOS PAC ID: 4385984566 Enrollment ID: I20190326001575 |
| Provider Name | Calandra N Harding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962050104 PECOS PAC ID: 8325378995 Enrollment ID: I20190924002942 |
| Provider Name | Joy Okwuchi Uwandu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528531498 PECOS PAC ID: 6800215591 Enrollment ID: I20200930000036 |
| Provider Name | Veronica I Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851910285 PECOS PAC ID: 0143640326 Enrollment ID: I20201009001768 |
| Provider Name | Ashley J Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609472679 PECOS PAC ID: 6608284898 Enrollment ID: I20210428002100 |
| Provider Name | Michelle Victoria Haywood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255947388 PECOS PAC ID: 9931564143 Enrollment ID: I20230421002577 |
| Provider Name | Njideka Emenyi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912567504 PECOS PAC ID: 1850722133 Enrollment ID: I20231109000193 |
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