MATCLINIC PHYSICIANS PRACTICE GROUP LLC (NPI# 1174175632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174175632 |
| Entity Type | Organization |
| Organization Name | MATCLINIC PHYSICIANS PRACTICE GROUP LLC |
| Practice Address |
107 Ridgely Ave Ste 12 Annapolis MD 21401-1417 |
| Mailing Address |
503 Albemarle St Baltimore MD 21202-4304 |
| Practice Telephone | 4102200780 |
| Practice Fax Number | 4108620150 |
| Mailing Telephone | 4102200780 |
| Mailing Fax Number | 4108620150 |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2020-08-07 |
| Authorized Official Name | DAN RECK (MANAGER) |
| Authorized Official Telephone | 4102200780 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 561008702 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548825813 | Matclinic Physicians Practice Group LLC | Counselor | 40 York Rd Ste 201, Towson, MD 21204-5243 | 2019-05-02 |
| 1356801534 | Matclinic Physicians Practice Group LLC | Internal Medicine | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2019-03-22 |
| 1194217091 | Matclinic Physicians Practice Group LLC | Counselor | 601 7th St Ste 304, Laurel, MD 20707-4011 | 2018-06-06 |
| 1699385336 | Matclinic Physicians Practice Group LLC | Clinic/Center | 40 York Rd Ste 201, Towson, MD 21204-5243 | 2020-08-07 |
| 1417567157 | Matclinic Physicians Practice Group LLC | Clinic/Center | 601 7th St Ste 304, Laurel, MD 20707-4011 | 2020-08-07 |
| 1336759075 | Matclinic Physicians Practice Group LLC | Clinic/Center | 40 S Dundalk Ave Ste 400, Dundalk, MD 21222-4273 | 2020-08-07 |
| 1316557051 | Matclinic Physicians Practice Group LLC | Clinic/Center | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2020-08-07 |
| 1841840808 | Matclinic Physicians Practice Group LLC | Community/Behavioral Health | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2019-09-12 |
| 1669022620 | Matclinic Physicians Practice Group LLC | Community/Behavioral Health | 40 York Rd Ste 201, Towson, MD 21204-5243 | 2019-09-12 |
| 1750930863 | Matclinic Physicians Practice Group LLC | Clinic/Center | 601 7th St Ste 304, Laurel, MD 20707-4011 | 2019-09-11 |
| Street Address |
107 RIDGELY AVE STE 12 |
| City | ANNAPOLIS |
| State | MD |
| Zip Code | 21401-1417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356801534 | Matclinic Physicians Practice Group LLC | Internal Medicine | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2019-03-22 |
| 1316557051 | Matclinic Physicians Practice Group LLC | Clinic/Center | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2020-08-07 |
| 1841840808 | Matclinic Physicians Practice Group LLC | Community/Behavioral Health | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2019-09-12 |
| 1821647934 | Matclinic Physicians Practice Group LLC | Clinic/Center | 107 Ridgely Ave Ste 12, Annapolis, MD 21401-1417 | 2019-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497377154 | Michael Khorsandi | Student in an Organized Health Care Education/Training Program | 2001 Medical Parkway, Clatanoff Pavillon, Gmw Office, Annapolis, MD 21401 | 2020-05-15 |
| 1275172033 | Katrice N Nelson | Massage Therapist | Wellsview Cottage Center, 613 Ridgely Avenue, Annapolis, MD 21401 | 2019-12-27 |
| 1548803521 | Victoria Reimnitz | Behavioral Analyst | 2028 Indusrtrial Dr, Ste B&c, Annapolis, MD 21401 | 2019-10-23 |
| 1700438140 | Emily Megan Burke | Nurse Practitioner | 200 Forbes St Annapolis, Md 21401, Suite 200, Annapolis, MD 21401 | 2019-07-16 |
| 1316504848 | Sherina Maryam Shamsa | Counselor | 1830 Forest Drive, Suite H-2, Annapolis, MD 21401 | 2019-05-21 |
| 1497225288 | Jerilyn Deitch | Speech-Language Pathologist | Anne Arundel County Public Schools, 2644 Riva Rd, Annapolis, MD 21401 | 2018-12-05 |
| 1487124038 | Lucinda W Mimms | Speech-Language Pathologist | 2644 Riva Rd., Annapolis, MD 21401 | 2018-11-27 |
| 1487145496 | Michelle Baudean | Behavior Technician | 1919 West St Ste 201, Annapolis, MD 21401 | 2018-05-24 |
| 1730678954 | Stephanie Ruth Streb | Registered Nurse | 130 Admiral Cochrane Dr Ste 103, Annapolis, MD 21401 | 2018-05-02 |
| 1780183947 | Annapolis Sleep Center LLC | Clinic/Center | 2451 Riva Rd, Annapolis, MD 21401 | 2018-02-02 |
| Find all providers in zip 21401 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164073417 | Jenna Darby Hirschmann | Counselor | 185 Admiral Cochrane Dr Ste 120, Annapolis, MD 21401-7600 | 2019-09-26 |
| 1225684582 | Hunter Hastings | Counselor | 2568 Riva Rd, Annapolis, MD 21401-7405 | 2019-08-13 |
| 1578079992 | Catherine M Quimby | Counselor | 34 Defense St Ste 100, Annapolis, MD 21401-3578 | 2017-12-21 |
| 1306399035 | Lacy Ann Hare | Counselor | 251 Rowe Blvd, Room 224, Annapolis, MD 21401-1539 | 2016-07-29 |
| 1982006193 | Therapeutic Value LLC | Counselor | 90 Edgewood Ave, Annapolis, MD 21401-4010 | 2014-09-18 |
| 1154765386 | John B Norris | Counselor | 2025 Harbour Gates Dr, Annapolis, MD 21401-2183 | 2013-04-18 |
| 1588956379 | Cynthia Beth Hurd | Counselor | 2610 Greenbriar Ln, Annapolis, MD 21401-4424 | 2011-05-11 |
| 1851509368 | George Scott Jakovics | Counselor | 1831 Forest Dr Ste D, Annapolis, MD 21401-4430 | 2007-05-18 |
| 1063561249 | Clean and Sober | Counselor | 929 West St, Suite 207, Annapolis, MD 21401-3626 | 2007-01-09 |
| 1255426573 | J'aime Nowell | Counselor | 1160 Spa Rd, Suite 1b, Annapolis, MD 21403-1022 | 2006-10-03 |
| Find all providers in ANNAPOLIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.