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General NPI Number Information
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NPI Number | 1760404255
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Entity Type | Individual
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Provider Name | PRASAD MATHEW MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 4845 ALAMEDA AVE
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City | EL PASO
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State | TX
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Zip | 79905-2705
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Country | US
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Telephone | 915-215-5700
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Fax | 915-215-8872
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Provider Business Mailing Address
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Address Line | 5130 GATEWAY BLVD E
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City | EL PASO
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State | TX
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Zip | 79905-1608
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Country | US
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Telephone | 915-215-4480
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Fax | 915-215-5386
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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 | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | V4706
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 99-83
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License Number State | NM
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