Provider Demographics
NPI:1699151522
Name:MATHIAS, PRIYANKA (MD)
Entity type:Individual
Prefix:MS
First Name:PRIYANKA
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 DORCHESTER CT STE 1
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6546
Mailing Address - Country:US
Mailing Address - Phone:574-537-1221
Mailing Address - Fax:
Practice Address - Street 1:2024 DORCHESTER CT STE 1
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6546
Practice Address - Country:US
Practice Address - Phone:574-537-1221
Practice Address - Fax:574-537-1225
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01093066A207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine