Provider Demographics
NPI:1881823862
Name:MATHUR, ANURADHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANURADHA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANURADHA
Other - Middle Name:
Other - Last Name:RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-246-1964
Mailing Address - Fax:
Practice Address - Street 1:7798 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7745
Practice Address - Country:US
Practice Address - Phone:513-475-7500
Practice Address - Fax:513-475-7501
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50 003602363A00000X
OH3602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230590Medicaid
OH0078764Medicaid
OH0078764Medicaid