Provider Demographics
NPI:1245229905
Name:PENDER, MATTHEW CONOR (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CONOR
Last Name:PENDER
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:35 GILBERT ST
Practice Address - Street 2:CAMBRIDGE MEDICAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2618
Practice Address - Country:US
Practice Address - Phone:518-677-3961
Practice Address - Fax:518-677-3180
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-06-29
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Provider Licenses
StateLicense IDTaxonomies
NY169666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00010326OtherRR MEDICARE
NY01020213Medicaid
NYP00010326OtherRR MEDICARE
B80691Medicare UPIN