Provider Demographics
NPI:1861136707
Name:MATHA, ANIRUDH (MD)
Entity type:Individual
Prefix:DR
First Name:ANIRUDH
Middle Name:
Last Name:MATHA
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 1:14132 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4340
Mailing Address - Country:US
Mailing Address - Phone:301-300-8390
Mailing Address - Fax:
Practice Address - Street 1:2550 MOSSIDE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3514
Practice Address - Country:US
Practice Address - Phone:412-457-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHS000007L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine