Individual
DR. MATTHEW GLEN SOUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-9800
(570) 271-6361
(570) 271-5785
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD444252
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027327010001
—
PA
01
—
244821
MEDICARE
PA
Enumeration date
07/20/2007
Last updated
08/17/2020
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