Provider Demographics
NPI:1083623466
Name:MATHEW, SCARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SCARIA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
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:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-1789
Mailing Address - Country:US
Mailing Address - Phone:410-326-6391
Mailing Address - Fax:410-326-6399
Practice Address - Street 1:11910 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2921
Practice Address - Country:US
Practice Address - Phone:410-326-6391
Practice Address - Fax:410-326-6399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234311800Medicaid
MD6167Medicare ID - Type Unspecified
MD234311800Medicaid