Provider Demographics
NPI:1083687388
Name:MATHEW, ALISON P (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:P
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 1:1150 1/2 LINCOLNWAY S
Mailing Address - Street 2:POST OFFICE BOX 319
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-1735
Mailing Address - Country:US
Mailing Address - Phone:260-894-7135
Mailing Address - Fax:260-894-7221
Practice Address - Street 1:1150 1/2 LINCOLNWAY S
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-1735
Practice Address - Country:US
Practice Address - Phone:260-894-7135
Practice Address - Fax:260-894-7221
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057035A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200417790Medicaid
H78669Medicare UPIN