Provider Demographics
NPI:1255122941
Name:MATTHEW SIEDHOFF MD PC
Entity type:Organization
Organization Name:MATTHEW SIEDHOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SIEDHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-687-4094
Mailing Address - Street 1:9903 STA MONICA BLVD # 208
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1606
Mailing Address - Country:US
Mailing Address - Phone:323-352-9552
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 311
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4320
Practice Address - Country:US
Practice Address - Phone:323-352-9552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1710182779Other1710182779
CA138819Other1710182779
NC2009-00884Other1710182779