Provider Demographics
NPI:1346243292
Name:MATHAI, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MATHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2203
Mailing Address - Country:US
Mailing Address - Phone:717-412-7226
Mailing Address - Fax:
Practice Address - Street 1:875 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2203
Practice Address - Country:US
Practice Address - Phone:717-412-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031068L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C28181Medicare UPIN
PA032798Medicare PIN