Basic Information
| Provider Information | |||||||||
| NPI: | 1245803584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLEGEN | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 6TH ST SW APT 311 | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200242669 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 23RD ST NW | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200372342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027154000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA200001192 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.