1326344342 NPI number — MR. MATTHEW ROBERT CHARVAT A.T.,C.

Table of content: MR. MATTHEW ROBERT CHARVAT A.T.,C. (NPI 1326344342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326344342 NPI number — MR. MATTHEW ROBERT CHARVAT A.T.,C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARVAT
Provider First Name:
MATTHEW
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326344342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 FORESTS EDGE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20724-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-928-2019
Provider Business Mailing Address Fax Number:
301-314-6549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GOSSETT FOOTBALL TEAM HOUSE
Provider Second Line Business Practice Location Address:
379 FIELD HOUSE DRIVE
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20742-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-314-9901
Provider Business Practice Location Address Fax Number:
301-314-6549
Provider Enumeration Date:
02/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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