Provider Demographics
NPI:1609864115
Name:MATHUR, SUMEET (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMEET
Middle Name:
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 1:1450 SCALP AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3374
Mailing Address - Country:US
Mailing Address - Phone:814-266-1185
Mailing Address - Fax:814-266-1199
Practice Address - Street 1:1450 SCALP AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3374
Practice Address - Country:US
Practice Address - Phone:814-266-1185
Practice Address - Fax:814-266-1199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064804L207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG71236Medicare UPIN
PA010406QJVMedicare ID - Type Unspecified