Provider Demographics
NPI:1093172918
Name:SAUDER, MAXWELL BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:BENJAMIN
Last Name:SAUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:LW503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-6571
Mailing Address - Fax:617-632-6727
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:LW503
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-6571
Practice Address - Fax:617-632-6727
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266239207N00000X
MA266236261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA