Provider Demographics
NPI:1194130070
Name:AN, MATHEW J (MS, ATC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:J
Last Name:AN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON AVE
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1172
Mailing Address - Country:US
Mailing Address - Phone:410-810-7495
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON AVE
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620
Practice Address - Country:US
Practice Address - Phone:410-810-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL35382255A2300X
MDA012292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer