Provider Demographics
NPI:1376705822
Name:MATHUR, ARUN DEEPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:DEEPAK
Last Name:MATHUR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:STE K
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9263
Mailing Address - Country:US
Mailing Address - Phone:419-824-1999
Mailing Address - Fax:419-882-7016
Practice Address - Street 1:5300 HARROUN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2182
Practice Address - Country:US
Practice Address - Phone:419-824-1999
Practice Address - Fax:419-882-7016
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-05-18
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Provider Licenses
StateLicense IDTaxonomies
OH35096157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3154349Medicaid
OH3154349Medicaid