Provider Demographics
NPI:1437150463
Name:MATHEW, RANJIT CHERIAN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:RANJIT
Middle Name:CHERIAN
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OGLETHORPE AVENUE
Mailing Address - Street 2:SUITE 600F
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-549-1222
Mailing Address - Fax:706-549-9975
Practice Address - Street 1:170 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2147
Practice Address - Country:US
Practice Address - Phone:706-549-1222
Practice Address - Fax:706-549-9975
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2014-08-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
GA037286207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000576837AMedicaid
E60097Medicare UPIN
10BBBQDMedicare ID - Type Unspecified