| Matrix House Physicians Pa | |
|
8118 Good Luck Rd Lanham MD 20706-3595 | |
| (301) 552-8118 | |
| (301) 498-3074 |
| Full Name | Matrix House Physicians Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 8118 Good Luck Rd, Lanham, Maryland |
| Authorized Official Name and Position | Nadehzda Kovalchuk (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3015528118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Matrix House Physicians Pa Po Box 17301 Baltimore MD 21297-1301 Ph: (301) 498-2922 | Matrix House Physicians Pa 8118 Good Luck Rd Lanham MD 20706-3595 Ph: (301) 552-8118 |
| NPI Number | 1780631556 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 11/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780631556 | NPI | - | NPPES |
| G479 | Other | DC | BCBS GROUP PROVIDER # |
| LL77MA | Other | MD | BCBS GROUP PROVIDER # |
| 055700500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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