Provider Demographics
NPI:1669413480
Name:SCUDERI, MATTHEW G (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6620 FLY ROAD
Mailing Address - Street 2:STE 200
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-464-4472
Mailing Address - Fax:315-464-5229
Practice Address - Street 1:6620 FLY ROAD
Practice Address - Street 2:STE 200
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-464-4472
Practice Address - Fax:315-464-5229
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY231541207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551279Medicaid
NYH88506Medicare UPIN