Provider Demographics
NPI:1083964415
Name:MATHEW, ANNU (RPA-C)
Entity Type:Individual
Prefix:
First Name:ANNU
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 HORIZON CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3907
Mailing Address - Country:US
Mailing Address - Phone:215-822-8400
Mailing Address - Fax:215-822-8099
Practice Address - Street 1:700 HORIZON CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3907
Practice Address - Country:US
Practice Address - Phone:215-822-8400
Practice Address - Fax:215-822-8099
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant