Provider Demographics
NPI:1497308753
Name:MATHUR, DEEPALI (FNP)
Entity Type:Individual
Prefix:
First Name:DEEPALI
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SANSOM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2915
Mailing Address - Country:US
Mailing Address - Phone:267-972-7163
Mailing Address - Fax:
Practice Address - Street 1:2137 WELSH RD STE 2E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4963
Practice Address - Country:US
Practice Address - Phone:215-747-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily