Healthcare Provider Details

I. General information

NPI: 1396718003
Provider Name (Legal Business Name): MONICA MATHUR D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36752 CRANLYN TER
AVON OH
44011-3481
US

IV. Provider business mailing address

36752 CRANLYN TER
AVON OH
44011-3481
US

V. Phone/Fax

Practice location:
  • Phone: 216-926-2160
  • Fax: 440-937-8334
Mailing address:
  • Phone: 216-926-2160
  • Fax: 440-937-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003278M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: