Provider Demographics
NPI:1598869216
Name:MATHUR, KEVIN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KUMAR
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2203
Mailing Address - Country:US
Mailing Address - Phone:330-264-9699
Mailing Address - Fax:330-264-7999
Practice Address - Street 1:1749 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2203
Practice Address - Country:US
Practice Address - Phone:330-264-9699
Practice Address - Fax:330-264-7999
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082464M207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444840Medicaid
OH2444840Medicaid
OHMA4122141Medicare ID - Type Unspecified