1912215112 NPI number — MATTHEW VOLTZ D.O.

Table of content: MATTHEW VOLTZ D.O. (NPI 1912215112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912215112 NPI number — MATTHEW VOLTZ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLTZ
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1912215112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 LIMESTONE RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-5408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-633-3555
Provider Business Mailing Address Fax Number:
302-633-3350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1941 LIMESTONE RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-5408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-633-3555
Provider Business Practice Location Address Fax Number:
302-633-3350
Provider Enumeration Date:
09/22/2010

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: 207Q00000X , with the licence number:  OS015269 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: C2-0010185 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2539927 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4723016 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P01267911 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912215112 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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