Provider Demographics
NPI:1578546065
Name:SEDGLEY, MATTHEW DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:SEDGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6314
Mailing Address - Country:US
Mailing Address - Phone:410-772-2000
Mailing Address - Fax:410-772-2039
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6314
Practice Address - Country:US
Practice Address - Phone:410-772-2000
Practice Address - Fax:410-772-2039
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN43792207Q00000X
MDD0073797207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34376700Medicaid
MN430080700Medicaid
MN080013911Medicare PIN
MN430080700Medicaid
WI34376700Medicaid