Healthcare Provider Details

I. General information

NPI: 1205977378
Provider Name (Legal Business Name): MARIA B. MATHIAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 WOODMAN DR STE 300
DAYTON OH
45420-1159
US

IV. Provider business mailing address

452 W MARKET ST
XENIA OH
45385-2815
US

V. Phone/Fax

Practice location:
  • Phone: 937-376-8700
  • Fax:
Mailing address:
  • Phone: 937-376-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-07-3415-M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35-07-3415-M
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: