Provider Demographics
NPI: | 1558392480 |
---|---|
Name: | MATHEW, ANNIE PHILIP (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANNIE |
Middle Name: | PHILIP |
Last Name: | MATHEW |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | ANNIE |
Other - Middle Name: | |
Other - Last Name: | PHILIP |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | PO BOX 3677 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHUA |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03061-3677 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-577-7900 |
Mailing Address - Fax: | 603-577-7972 |
Practice Address - Street 1: | 399 DANIEL WEBSTER HWY |
Practice Address - Street 2: | |
Practice Address - City: | MERRIMACK |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03054-4112 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-429-1611 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-06 |
Last Update Date: | 2016-01-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NH | 12436 | 207RI0200X, 208M00000X, 207RI0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 3077816 | Medicaid | |
NH | 3077816 | Medicaid | |
NH | RE784901 | Medicare PIN |