Provider Demographics
NPI:1659307627
Name:MATHEW, ALEYAMMA J (MD)
Entity Type:Individual
Prefix:
First Name:ALEYAMMA
Middle Name:J
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BLOOMSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4641
Mailing Address - Country:US
Mailing Address - Phone:410-744-8877
Mailing Address - Fax:410-869-3600
Practice Address - Street 1:5 BLOOMSBURY AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4641
Practice Address - Country:US
Practice Address - Phone:410-744-8877
Practice Address - Fax:410-869-3600
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD397801000Medicaid
MD417596-01 & 02OtherBLUE CROSS/BLUE SHIELD
MD6391OtherMEDICARE - PRIVATE PRACTICE
MDC89197Medicare UPIN
MDS085CE52Medicare PIN
MD110092857Medicare PIN
MD417596-01 & 02OtherBLUE CROSS/BLUE SHIELD