MEDICARE: DR. MATTHEW DANIEL SEDGLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	43792	MN
2	207QS0010X	Sports Medicine (Family Medicine) Physician	D0073797	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578546065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DANIEL SEDGLEY MD

Provider Business Mailing Address
First Line	:	9501 OLD ANNAPOLIS RD
Second Line	:	SUITE 220
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6314
Country	:	US
Telephone Number	:	410-772-2000
Fax Number	:	410-772-2039

Provider Business Practice Location Address
First Line	:	9501 OLD ANNAPOLIS RD
Second Line	:	SUITE 220
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6314
Country	:	US
Telephone Number	:	410-772-2000
Fax Number	:	410-772-2039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	11/20/2012

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