Provider Demographics
NPI:1639499841
Name:MATHUR, ASHISH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
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 1:422 RAY NORRISH DR # 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1520
Mailing Address - Country:US
Mailing Address - Phone:513-671-6707
Mailing Address - Fax:513-671-6710
Practice Address - Street 1:422 RAY NORRISH DR # 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1520
Practice Address - Country:US
Practice Address - Phone:513-671-6707
Practice Address - Fax:513-671-6710
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129279207K00000X
IN01077122A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201367500Medicaid
IN201367500Medicaid
OHH449730Medicare PIN