Provider Demographics
NPI:1508845355
Name:MATHEW, SAJINI (MD)
Entity Type:Individual
Prefix:
First Name:SAJINI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632242
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2242
Mailing Address - Country:US
Mailing Address - Phone:800-503-6254
Mailing Address - Fax:
Practice Address - Street 1:7500 STATE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2439
Practice Address - Country:US
Practice Address - Phone:513-624-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082298207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200473820AMedicaid
IN200473820EMedicaid
OH2414613Medicaid
IN200473820CMedicaid
IN200473820FMedicaid
IN200473820DMedicaid
KY64073422Medicaid
OH2414613Medicaid
OHMA4106022Medicare ID - Type Unspecified
IN200473820FMedicaid
OHMA4106023Medicare ID - Type Unspecified
KY64073422Medicaid