Provider Demographics
NPI:1013406396
Name:MATHEW, ASWATHI ELSA (MD)
Entity Type:Individual
Prefix:
First Name:ASWATHI
Middle Name:ELSA
Last Name:MATHEW
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 1:99 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1293
Mailing Address - Country:US
Mailing Address - Phone:518-773-5690
Mailing Address - Fax:518-773-5620
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1293
Practice Address - Country:US
Practice Address - Phone:518-773-5690
Practice Address - Fax:518-773-5620
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475498207R00000X
NY321837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine