Provider Demographics
NPI:1538198734
Name:BELZAK, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BELZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29466 PINTAIL DR
Mailing Address - Street 2:STE 8
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-9324
Mailing Address - Country:US
Mailing Address - Phone:443-746-2045
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:5233 KING AVE
Practice Address - Street 2:STE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4003
Practice Address - Country:US
Practice Address - Phone:410-294-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167314367500000X
DC1002703207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019116M65Medicare ID - Type Unspecified
Q65763Medicare UPIN