Provider Demographics
NPI:1093895476
Name:MATHUR, ANITA K (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:K
Last Name:MATHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 SOUTH VOLUSIA AVENUE
Mailing Address - Street 2:STE 102
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6564
Mailing Address - Country:US
Mailing Address - Phone:386-774-7337
Mailing Address - Fax:385-774-7445
Practice Address - Street 1:999 SOUTH VOLUSIA AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6564
Practice Address - Country:US
Practice Address - Phone:386-774-7337
Practice Address - Fax:385-774-7445
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME67495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37584OtherBCBS
FL379425300Medicaid