Provider Demographics
NPI:1417951005
Name:ZINDER, MATTHEW D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:ZINDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 KINGS COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-440-0312
Mailing Address - Fax:410-825-6654
Practice Address - Street 1:3 GREENWOOD PLACE
Practice Address - Street 2:SUITE 300
Practice Address - City:PIKESVILLE
Practice Address - State:NA
Practice Address - Zip Code:21208
Practice Address - Country:UM
Practice Address - Phone:410-580-0004
Practice Address - Fax:410-580-0000
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001176997163W00000X
VA0024166147164W00000X
MDR146704367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD154795OtherMEDICARE PTAN
VA010058121Medicaid