NPIMap

Organization Active NPI

Matthew Raider MD LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Middletown, CT
National Provider Identifier
1093952194
Registry record updated Feb 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
22948 Issued in CT
Legal business name
MATTHEW RAIDER MD LLC
Practice address
645 Saybrook Rd
Middletown, CT 06457-4746
Phone
(860) 767-4024
NPI assigned
Jan 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew J Raider, M.D.NPI 1073562674
Title
Sole Proprietor
Phone
(860) 767-4024

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X 22948 CT Primary

Addresses

Primary practice location

645 Saybrook Rd
Middletown, CT 06457-4746

Mailing address

645 Saybrook Rd
Middletown, CT 06457-4746
Phone (860) 767-4024

National Provider Directory

National Provider Directory

Locations

333 Main St
Portland, CT 06480
Phone (860) 342-0370

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1093952194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 SAYBROOK RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574746",
            "telephone_number": "860-767-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 SAYBROOK RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574746",
            "telephone_number": "860-767-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW RAIDER MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-11",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "RAIDER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "860-767-4024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CT",
            "license": "22948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.