Healthcare Provider Details

I. General information

NPI: 1225650922
Provider Name (Legal Business Name): MATHANGI SURESH KESHAVAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MATHANGI SURESH

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S 13TH ST STE 300
MOUNT VERNON WA
98274-4100
US

IV. Provider business mailing address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO.OP.70126206
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberDO.OP.70126206
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: