MEDICARE: DINESH P MATHUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD016204E	PA

General Provider Information

NPI Number	:	1427053487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINESH P MATHUR MD

Provider Business Mailing Address
First Line	:	1086 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4305
Country	:	US
Telephone Number	:	814-410-8300
Fax Number	:	814-410-8331

Provider Business Practice Location Address
First Line	:	1450 SCALP AVE
Second Line	:	SUITE 1055
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3374
Country	:	US
Telephone Number	:	814-535-4520
Fax Number	:	814-539-4721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/04/2013

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