Provider Demographics
NPI:1649387515
Name:LAUREL ENT & ALLERGY PC
Entity Type:Organization
Organization Name:LAUREL ENT & ALLERGY PC
Other - Org Name:SAM MATHUR, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-349-4360
Mailing Address - Street 1:850 HOSPITAL RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3662
Mailing Address - Country:US
Mailing Address - Phone:724-349-4360
Mailing Address - Fax:724-463-1847
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-349-4360
Practice Address - Fax:724-463-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064804L207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID NUMBER