Basic Information
| Provider Information | |||||||||
| NPI: | 1861755514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATZ | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 WILMINGTON W CHESTER PIKE | ||||||||
| Address2: | STE 214 | ||||||||
| City: | CHADDS FORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193173766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 8445160080 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 SILVERSIDE ROAD, STE 104 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198091768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 8445160080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P27690 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207LP2900X | D0083982 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | MD460644 | PA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0000X | D0083982 | MD | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0000X | C1-0012811 | DE | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 578018700 | 05 | MD | MEDICAID | 250533585 | 05 | DE | MEDICAID | 103612207 | 05 | PA | MEDICAID |