Provider Demographics
NPI:1710380381
Name:EDLER, MATTHEW JEREMY (MA, MT-BC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JEREMY
Last Name:EDLER
Suffix:
Gender:M
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31618 HOLLY CT # H144
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-2051
Mailing Address - Country:US
Mailing Address - Phone:302-593-7784
Mailing Address - Fax:
Practice Address - Street 1:31618 HOLLY CT # H144
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-2051
Practice Address - Country:US
Practice Address - Phone:302-593-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor