Healthcare Provider Details

I. General information

NPI: 1699909481
Provider Name (Legal Business Name): MATTHEW RIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SISKIN PLZ STE 101
CHATTANOOGA TN
37403-1306
US

IV. Provider business mailing address

1 SISKIN PLZ STE 101
CHATTANOOGA TN
37403-1306
US

V. Phone/Fax

Practice location:
  • Phone: 423-803-2226
  • Fax: 423-803-2222
Mailing address:
  • Phone: 423-803-2226
  • Fax: 423-803-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11014831A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number73051
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD49617
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: