Provider Demographics
NPI:1205083102
Name:MATHEW, AMY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANN
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3534 URBANA PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7786
Mailing Address - Country:US
Mailing Address - Phone:240-341-1090
Mailing Address - Fax:240-877-7110
Practice Address - Street 1:3534 URBANA PIKE STE A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7786
Practice Address - Country:US
Practice Address - Phone:240-341-1090
Practice Address - Fax:240-877-7110
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0068729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028290100Medicaid