Provider Demographics
NPI:1720276587
Name:SHAJI MATHEW MD., P.C.
Entity Type:Organization
Organization Name:SHAJI MATHEW MD., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAJI
Authorized Official - Middle Name:O
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:775-827-3639
Mailing Address - Street 1:3639 WARREN WAY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-827-3639
Mailing Address - Fax:775-827-3638
Practice Address - Street 1:3639 WARREN WAY
Practice Address - Street 2:SUITE #100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-827-3639
Practice Address - Fax:775-827-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty