Provider Demographics
NPI:1407533573
Name:GAURAV N MATHUR MD PA
Entity Type:Organization
Organization Name:GAURAV N MATHUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-621-0476
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32781-1494
Mailing Address - Country:US
Mailing Address - Phone:321-621-0476
Mailing Address - Fax:
Practice Address - Street 1:7139 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5094
Practice Address - Country:US
Practice Address - Phone:321-621-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty