Provider Demographics
NPI:1346528296
Name:MATHEW, AJAY (DO)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:36763 EILAND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-0600
Practice Address - Country:US
Practice Address - Phone:813-994-3389
Practice Address - Fax:813-355-5051
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14176207RN0300X
FL1346528296207RN0300X
FLUO2888207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019525800Medicaid
FL019525800Medicaid
FLIV870Y-TPAMedicare PIN
FLP01806435-RAILROADMedicare PIN