Healthcare Provider Details

I. General information

NPI: 1639499841
Provider Name (Legal Business Name): ASHISH KUMAR MATHUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 RAY NORRISH DR # 2
CINCINNATI OH
45246-1520
US

IV. Provider business mailing address

422 RAY NORRISH DR # 2
CINCINNATI OH
45246-1520
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-6707
  • Fax: 513-671-6710
Mailing address:
  • Phone: 513-671-6707
  • Fax: 513-671-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.129279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: