Basic Information
Provider Information
NPI: 1124245972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAUDER
FirstName: MATTHEW
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2112 HARRISBURG PIKE
Address2: STE 200
City: LANCASTER
State: PA
PostalCode: 176012644
CountryCode: US
TelephoneNumber: 7175443059
FaxNumber: 7175443638
Practice Location
Address1: 2112 HARRISBURG PIKE
Address2: STE 200
City: LANCASTER
State: PA
PostalCode: 176012644
CountryCode: US
TelephoneNumber: 7175443059
FaxNumber: 7175443638
Other Information
ProviderEnumerationDate: 04/20/2007
LastUpdateDate: 10/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101XMD433570PAY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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