Provider Demographics
NPI:1134409782
Name:MATHEW, PHILIP (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1040
Mailing Address - Country:US
Mailing Address - Phone:602-437-0097
Mailing Address - Fax:
Practice Address - Street 1:2420 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1040
Practice Address - Country:US
Practice Address - Phone:602-437-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06527900207R00000X, 207RI0200X
NE30470207R00000X
AZ57283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH27656Medicare UPIN