Provider Demographics
NPI:1912985615
Name:MATHARU, TARVINDER SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:TARVINDER
Middle Name:SINGH
Last Name:MATHARU
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 1:7830 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5704
Mailing Address - Country:US
Mailing Address - Phone:317-888-1100
Mailing Address - Fax:317-888-1118
Practice Address - Street 1:7830 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5704
Practice Address - Country:US
Practice Address - Phone:317-888-1100
Practice Address - Fax:317-888-1118
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86742207R00000X, 207RC0000X
KY39845207R00000X, 207RC0000X
IN01077285A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2609421Medicaid
KY64122583Medicaid
OH2609421Medicaid
KY00772005Medicare PIN