Healthcare Provider Details

I. General information

NPI: 1396805362
Provider Name (Legal Business Name): ARUN KUMAR MATHUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 CLEVELAND RD
WOOSTER OH
44691-2203
US

IV. Provider business mailing address

1749 CLEVELAND RD
WOOSTER OH
44691-2203
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-9699
  • Fax: 330-264-7999
Mailing address:
  • Phone: 330-264-9699
  • Fax: 330-264-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number35035820M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: