Provider Demographics
NPI:1972694297
Name:MATHEW, RANO THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RANO
Middle Name:THOMAS
Last Name:MATHEW
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 1:1907 S 17TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6626
Mailing Address - Country:US
Mailing Address - Phone:910-343-8424
Mailing Address - Fax:910-343-6989
Practice Address - Street 1:1907 S 17TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6626
Practice Address - Country:US
Practice Address - Phone:910-343-8424
Practice Address - Fax:910-343-6989
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96001122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136WYMedicaid
NC2450205DMedicare ID - Type UnspecifiedINDIVIDUAL
NC89136WYMedicaid