Provider Demographics
NPI:1790951127
Name:MATHUR, DEEPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAN
Middle Name:
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 1:6511 SW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5606
Mailing Address - Country:US
Mailing Address - Phone:785-608-5133
Mailing Address - Fax:
Practice Address - Street 1:936 SW 1ST ST.
Practice Address - Street 2:SUITE 428
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:785-608-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451133207ZP0102X
FLME124783207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty