Provider Demographics
NPI:1639119910
Name:SANGER, MATTHEW K (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:K
Last Name:SANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 ARCH ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2857
Mailing Address - Country:US
Mailing Address - Phone:215-382-3680
Mailing Address - Fax:215-382-3683
Practice Address - Street 1:1 GALLERIA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2082
Practice Address - Country:US
Practice Address - Phone:504-708-4400
Practice Address - Fax:504-708-4410
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15620R207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1464953Medicaid
LA1464953Medicaid
LA4J159DG27Medicare PIN
LA4J159Medicare ID - Type Unspecified
H47693Medicare UPIN