Provider Demographics
NPI:1861660789
Name:CJOSEPH MATHEW MD PC
Entity Type:Organization
Organization Name:CJOSEPH MATHEW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-249-2119
Mailing Address - Street 1:1467 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2652
Mailing Address - Country:US
Mailing Address - Phone:978-249-2119
Mailing Address - Fax:978-249-9311
Practice Address - Street 1:1467 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2652
Practice Address - Country:US
Practice Address - Phone:978-249-2119
Practice Address - Fax:978-249-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2060892Medicaid
MA2060892Medicaid