Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35-07-2898-L | OH |
NPI | 1194731398 |
---|---|
Provider Name | Dr. Matthew A Langenderfer |
First Address | Cincinnati, OH 45249-2231 |
Second Address | Cincinnati, OH 45249-2231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200038620 | MEDICARE RAILROAD (01) | OH |
200-257070A | (05) | IN |
2197591 | (05) | OH |
64-013584 | (05) | KY |
H16334 | (02) | OH |