Active NPI
Colleen Frances Matulaitis, NP
- Family Nurse Practitioner
- Berlin, MD
National Provider Identifier
1609258664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R076432
- Practice address
- 11101 Cathage Rd.
Suite 102
Berlin, MD 21811 - Phone
- (410) 912-6104
- Fax
- (410) 912-6105
- NPI assigned
- Jun 25, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R076432 | MD | Primary |
Addresses
Primary practice location
11101 Cathage Rd.
Suite 102
Berlin, MD 21811
Mailing address
11101 Cathage Rd.
Suite 102
Berlin, MD 21811
Phone (410) 912-6104
Other practice location 1
1310 Belmont Ave Ste 302
Salisbury, MD 21804-4506
Phone (443) 358-5388
Other names 1
- Ms. Colleen Frances King
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1609258664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11101 CATHAGE RD.",
"address_2": "SUITE 102",
"city": "BERLIN",
"state": "MD",
"postal_code": "21811",
"telephone_number": "410-912-6104",
"fax_number": "410-912-6105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11101 CATHAGE RD.",
"address_2": "SUITE 102",
"city": "BERLIN",
"state": "MD",
"postal_code": "21811",
"telephone_number": "410-912-6104",
"fax_number": "410-912-6105"
}
],
"practiceLocations": [
{
"address_1": "1310 Belmont Ave Ste 302",
"address_purpose": "LOCATION",
"city": "Salisbury",
"state": "MD",
"postal_code": "218044506",
"country_code": "US",
"telephone_number": "443-358-5388",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MATULAITIS",
"first_name": "COLLEEN",
"middle_name": "FRANCES",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-25",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R076432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "COLLEEN",
"last_name": "KING",
"middle_name": "FRANCES",
"prefix": "MS.",
"credential": "CRNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.