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General NPI Number Information
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NPI Number | 1518617893
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Entity Type | Individual
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Provider Name | POOJA RITESH MATADAR MD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2211 MAYFAIR DR STE 409
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City | OWENSBORO
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State | KY
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Zip | 42301
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Country | US
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Telephone | 270-417-7980
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Fax | 270-417-7989
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Provider Business Mailing Address
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Address Line | PO BOX 23229
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City | OWENSBORO
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State | KY
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Zip | 42304-3229
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Country | US
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Telephone | 270-691-8070
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 59662
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License Number State | KY
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