Provider Demographics
NPI:1811197619
Name:MATADEEN-ALI, CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:MATADEEN-ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MOUNT AIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-3357
Mailing Address - Country:US
Mailing Address - Phone:484-557-5289
Mailing Address - Fax:
Practice Address - Street 1:4 MOUNT AIRE FARM RD
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-3357
Practice Address - Country:US
Practice Address - Phone:484-557-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA264206207RS0012X
PAMD426885207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102032552-0003Medicaid