Active NPI
Maxwell Benjamin Sauder, M.D.
- Dermatology Physician
- Boston, MA
National Provider Identifier
1093172918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 266239
- Practice address
- 450 Brookline Ave
Lw503
Boston, MA 02215-5418 - Phone
- (617) 632-6571
- Fax
- (617) 632-6727
- NPI assigned
- Jan 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 266239 | MA | Primary |
| VA Clinic/Center | 261QV0200X | 266236 | MA |
Addresses
Primary practice location
450 Brookline Ave
Lw503
Boston, MA 02215-5418
Mailing address
450 Brookline Ave
Lw503
Boston, MA 02215-5418
Phone (617) 632-6571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 266236 | MA | MD | VA Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491004800000",
"number": "1093172918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"address_2": "LW503",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155418",
"telephone_number": "617-632-6571",
"fax_number": "617-632-6727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 BROOKLINE AVE",
"address_2": "LW503",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155418",
"telephone_number": "617-632-6571",
"fax_number": "617-632-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAUDER",
"first_name": "MAXWELL",
"middle_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-01-22",
"last_updated": "2017-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MA",
"license": "266239",
"primary": true
},
{
"code": "261QV0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, VA",
"state": "MA",
"license": "266236",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.