Provider Demographics
NPI:1689745986
Name:MATHUR, MONIKA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:
Last Name:MATHUR
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 1:909 9TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-336-7191
Mailing Address - Fax:817-877-4015
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-336-7191
Practice Address - Fax:817-877-4015
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102788207Q00000X
MA233621207Q00000X
TXP3199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00427422OtherMEDICARE RAILROAD
TX307093002Medicaid
MN624457000Medicaid
MN080015425Medicare ID - Type Unspecified
MN624457000Medicaid
TX335767YNGSMedicare PIN