Basic Information
| Provider Information | |||||||||
| NPI: | 1912215112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOLTZ | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026333555 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026333555 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2010 | ||||||||
| LastUpdateDate: | 04/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS015269 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | C2-0010185 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2539927 | 01 | DE | COVENTRY | OTHER | 4723016 | 01 | DE | AETNA | OTHER | P01267911 | 01 | RR MEDICARE | OTHER | 1912215112 | 05 | DE | MEDICAID |