Provider Demographics
NPI:1821181769
Name:MATHUR, UMA RANI (MD)
Entity Type:Individual
Prefix:
First Name:UMA
Middle Name:RANI
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:PO BOX 10120
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-0120
Mailing Address - Country:US
Mailing Address - Phone:321-631-6402
Mailing Address - Fax:321-633-7041
Practice Address - Street 1:502 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3405
Practice Address - Country:US
Practice Address - Phone:321-383-0298
Practice Address - Fax:321-383-2006
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21024Medicare UPIN
05578ZMedicare ID - Type Unspecified