Provider Demographics
NPI:1720217961
Name:MATHUR, DEEPALI
Entity Type:Individual
Prefix:
First Name:DEEPALI
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1718
Mailing Address - Country:US
Mailing Address - Phone:860-714-4440
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2118
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1718
Practice Address - Country:US
Practice Address - Phone:860-714-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003383207V00000X
CT49092207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology