Provider Demographics
NPI:1093755134
Name:MATHEW, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1601 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1404
Mailing Address - Country:US
Mailing Address - Phone:260-356-4005
Mailing Address - Fax:260-356-3501
Practice Address - Street 1:1601 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1404
Practice Address - Country:US
Practice Address - Phone:260-356-4005
Practice Address - Fax:260-356-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035103A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100138210AMedicaid
INC24895Medicare UPIN
IN100138210AMedicaid