Provider Demographics
NPI:1215947049
Name:JOSEPH, MATHUKUTTY (MD)
Entity type:Individual
Prefix:DR
First Name:MATHUKUTTY
Middle Name:
Last Name:JOSEPH
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 1:393 OAK STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-1531
Mailing Address - Country:US
Mailing Address - Phone:828-287-3928
Mailing Address - Fax:828-286-3137
Practice Address - Street 1:393 OAK STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-1531
Practice Address - Country:US
Practice Address - Phone:828-287-3928
Practice Address - Fax:828-286-3137
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-005962084P0800X
NY227931-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00716057OtherMEDICARE RAILROAD
182182OtherMEDCOST
NC5907501Medicaid
NC046V1OtherBCBS
182182OtherMEDCOST
2045533Medicare ID - Type Unspecified