Provider Demographics
NPI:1093804296
Name:MATHUR, RAMESHWAR NARAYAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMESHWAR
Middle Name:NARAYAN
Last Name:MATHUR
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 1:6250 N US 1
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-4926
Mailing Address - Country:US
Mailing Address - Phone:321-631-6402
Mailing Address - Fax:321-633-7041
Practice Address - Street 1:6250 N US 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-4926
Practice Address - Country:US
Practice Address - Phone:321-631-6402
Practice Address - Fax:321-633-7041
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51340Medicare UPIN
05537ZMedicare ID - Type Unspecified