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General NPI Number Information
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NPI Number | 1710061817
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Entity Type | Individual
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Provider Name | MATHEW NINAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 4230 HARDING PIKE SUITE 523
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City | NASHVILLE
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State | TN
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Zip | 37205-2013
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Country | US
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Telephone | 615-467-1060
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Fax | 615-467-1061
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Provider Business Mailing Address
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Address Line | 6006 49TH ST N STE 310
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2149
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Country | US
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Telephone | 727-527-9779
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Fax | 727-522-0415
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME140763
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD34573
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME140763
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License Number State | FL
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