Provider Demographics
NPI:1821105651
Name:MATSAM MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:MATSAM MEDICAL GROUP, INC.
Other - Org Name:OB-GYN ASSOCIATES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOGINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-8004
Mailing Address - Street 1:1383 E HERNDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3302
Mailing Address - Country:US
Mailing Address - Phone:559-449-8004
Mailing Address - Fax:559-449-8037
Practice Address - Street 1:1383 E HERNDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3302
Practice Address - Country:US
Practice Address - Phone:559-449-8004
Practice Address - Fax:559-449-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0054930Medicaid
CAMMM00035MMedicare ID - Type UnspecifiedMEDICARE PROVIDER#