Healthcare Provider Details

I. General information

NPI: 1114251451
Provider Name (Legal Business Name): DEEPA MATHUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEPA KANNA

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 4330
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

3525 OLENTANGY RIVER RD STE 4330
COLUMBUS OH
43214-3937
US

V. Phone/Fax

Practice location:
  • Phone: 614-255-6900
  • Fax: 614-255-6901
Mailing address:
  • Phone: 614-255-6900
  • Fax: 614-255-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.120275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: