Healthcare Provider Details

I. General information

NPI: 1063617975
Provider Name (Legal Business Name): MATTHEW ISRAEL ADLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD SUITE 210
HANOVER MD
21076-1213
US

IV. Provider business mailing address

7556 TEAGUE RD SUITE 210
HANOVER MD
21076-1213
US

V. Phone/Fax

Practice location:
  • Phone: 410-551-0499
  • Fax: 410-799-9070
Mailing address:
  • Phone: 410-551-0499
  • Fax: 410-799-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD71101
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD439290
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: