Healthcare Provider Details

I. General information

NPI: 1184156010
Provider Name (Legal Business Name): ANTONY MATHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DR
VALLEJO CA
94589-2574
US

IV. Provider business mailing address

15 WOODLAWN AVE APT B
ALBANY NY
12208-3225
US

V. Phone/Fax

Practice location:
  • Phone: 925-225-5837
  • Fax: 925-225-5838
Mailing address:
  • Phone: 239-822-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA169892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME151315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: