Healthcare Provider Details

I. General information

NPI: 1609864115
Provider Name (Legal Business Name): SUMEET MATHUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SCALP AVE SUITE 9
JOHNSTOWN PA
15904-3374
US

IV. Provider business mailing address

1450 SCALP AVE SUITE 9
JOHNSTOWN PA
15904-3374
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-1185
  • Fax: 814-266-1199
Mailing address:
  • Phone: 814-266-1185
  • Fax: 814-266-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD064804L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: