Provider Demographics
NPI:1639272883
Name:MATHESON, DONALD SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SAMUEL
Last Name:MATHESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:135 W 27TH ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6226
Mailing Address - Country:US
Mailing Address - Phone:212-255-8992
Mailing Address - Fax:212-463-9526
Practice Address - Street 1:135 W 27TH ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6226
Practice Address - Country:US
Practice Address - Phone:212-255-8992
Practice Address - Fax:212-463-9526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169748207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134078803OtherAETNA USHEALTH
NY299469OtherGHI
NY95D301OtherBC/BS
NYP786723OtherOXFORD
NY2C2763OtherHEALTHNET
NY18003 PRIS#29310POtherHIP HEALTH
NY18003 PRIS#29310POtherHIP HEALTH