Provider Demographics
NPI:1104265438
Name:MATHEW, CAROL M (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100276
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0276
Mailing Address - Country:US
Mailing Address - Phone:352-265-7996
Mailing Address - Fax:352-265-7996
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2903
Practice Address - Country:US
Practice Address - Phone:352-265-0301
Practice Address - Fax:508-334-6490
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA269221207R00000X
FLME146143207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107538800Medicaid