Provider Demographics
NPI:1902032865
Name:MATHAI, ANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:MATHAI
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 1:504 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2515
Mailing Address - Country:US
Mailing Address - Phone:716-366-9008
Mailing Address - Fax:716-366-3158
Practice Address - Street 1:504 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2515
Practice Address - Country:US
Practice Address - Phone:716-366-9008
Practice Address - Fax:716-366-3158
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003313207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine