Provider Demographics
NPI:1164620811
Name:MATHEW, ANUPAMA K (MD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:K
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANU
Other - Middle Name:K
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11773
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0013
Mailing Address - Country:US
Mailing Address - Phone:480-907-7707
Mailing Address - Fax:480-907-7097
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-3840
Practice Address - Fax:623-285-2602
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32945174400000X
IN01092255A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist