Provider Demographics
NPI:1861950446
Name:STAMPE, MATTHEW LAWRENCE (LAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:STAMPE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 CATLETT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3901
Mailing Address - Country:US
Mailing Address - Phone:703-776-0630
Mailing Address - Fax:
Practice Address - Street 1:3343 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-5219
Practice Address - Country:US
Practice Address - Phone:703-259-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006078225700000X
VA0121000941171100000X
DCAC500315171100000X
MDU02615171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist