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General NPI Number Information
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NPI Number | 1093767956
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Entity Type | Individual
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Provider Name | MATHEW JOSEPH ULAHANNAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1656 CHAMPLIN AVE
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-735-6141
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Fax | 315-735-4391
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Provider Business Mailing Address
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Address Line | 1656 CHAMPLIN AVE
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-735-6141
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Fax | 315-735-4391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 170995
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License Number State | NY
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