Provider Demographics
NPI:1134218357
Name:RAMESHWAR N MATHUR MD PA
Entity type:Organization
Organization Name:RAMESHWAR N MATHUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMESHWAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-631-6402
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 1:6250 N US 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927
Practice Address - Country:US
Practice Address - Phone:321-631-6402
Practice Address - Fax:321-633-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044769207Q00000X
FLME0046184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K1627Medicare ID - Type Unspecified