Healthcare Provider Details

I. General information

NPI: 1194731398
Provider Name (Legal Business Name): MATTHEW A LANGENDERFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 CORNELL RD
CINCINNATI OH
45249-2231
US

IV. Provider business mailing address

8099 CORNELL RD
CINCINNATI OH
45249-2231
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-3933
  • Fax: 513-793-8299
Mailing address:
  • Phone: 513-354-3700
  • Fax: 513-793-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35-07-2898-L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: