Provider Demographics
NPI:1841260130
Name:LOUDIS, MATTHEW (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:LOUDIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 READING AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1140
Mailing Address - Country:US
Mailing Address - Phone:610-374-7583
Mailing Address - Fax:610-374-2210
Practice Address - Street 1:200 READING AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1140
Practice Address - Country:US
Practice Address - Phone:610-374-7583
Practice Address - Fax:610-374-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003257L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480033187OtherRAILROAD MEDICARE
PA23-3044687OtherEIN
PAT30380Medicare UPIN
PA428759Medicare PIN
PA23-3044687OtherEIN