Provider Demographics
NPI:1396718003
Name:MATHUR, MONICA (DPM)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36752 CRANLYN TER
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3481
Mailing Address - Country:US
Mailing Address - Phone:216-926-2160
Mailing Address - Fax:440-937-8334
Practice Address - Street 1:36752 CRANLYN TER
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-3481
Practice Address - Country:US
Practice Address - Phone:216-926-2160
Practice Address - Fax:440-937-8334
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003278M213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4553650001OtherDMERC
OH2305633Medicaid
MIU89129Medicare UPIN
OH2305633Medicaid