Provider Demographics
NPI:1619979002
Name:MATHUR, AJAY K (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:K
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-446-8686
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:1029 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1564
Practice Address - Country:US
Practice Address - Phone:724-258-9680
Practice Address - Fax:724-258-3193
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039612L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009962610002Medicaid
PA0009962610002Medicaid
PAC34502Medicare UPIN