Healthcare Provider Details

I. General information

NPI: 1841378098
Provider Name (Legal Business Name): MATHUR HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 PORTAGE ST
SUMMERHILL PA
15958-3406
US

IV. Provider business mailing address

2324 PORTAGE ST
SUMMERHILL PA
15958-3406
US

V. Phone/Fax

Practice location:
  • Phone: 814-243-8055
  • Fax:
Mailing address:
  • Phone: 814-243-8055
  • Fax:

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: MRS. TRACIE L MINOR
Title or Position: OFFICE MANAGER
Credential: CST
Phone: 814-322-2348