Provider Demographics
NPI:1811061104
Name:MATHUR, ANIL K (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:K
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5325
Mailing Address - Country:US
Mailing Address - Phone:716-631-9477
Mailing Address - Fax:716-631-3954
Practice Address - Street 1:5285 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5325
Practice Address - Country:US
Practice Address - Phone:716-631-9477
Practice Address - Fax:716-631-3954
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00505183001OtherBLUE CROSS BLUE SHIELD
NY0403026OtherINDEPENDENT HEALTH
NY00010112701OtherUNIVERA
NY00647383Medicaid
NY0403026OtherINDEPENDENT HEALTH
NY00647383Medicaid