Healthcare Provider Details

I. General information

NPI: 1528054954
Provider Name (Legal Business Name): ANIL MATHEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E RIVER DR 5TH FLOOR
EAST HARTFORD CT
06108-3288
US

IV. Provider business mailing address

99 E RIVER DR 5TH FLOOR
EAST HARTFORD CT
06108-3288
US

V. Phone/Fax

Practice location:
  • Phone: 860-282-4022
  • Fax: 860-289-0746
Mailing address:
  • Phone: 860-282-4022
  • Fax: 860-289-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number038154
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number038154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: