Provider Demographics
NPI:1326517608
Name:VANDERMEID, MATTHEW RICHARD (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RICHARD
Last Name:VANDERMEID
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-6370
Mailing Address - Fax:585-368-6371
Practice Address - Street 1:2300 BUFFALO RD BLDG 800
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-368-6370
Practice Address - Fax:585-368-6371
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY027104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical