MEDICARE: DR. LAJU M MATHEW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	278553	NY
2	207N00000X	Dermatology Physician	ME147135	FL

General Provider Information

NPI Number	:	1235438466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAJU M MATHEW MD

Provider Business Mailing Address
First Line	:	9897 HAGEN RANCH RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6700
Country	:	US
Telephone Number	:	561-364-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	9897 HAGEN RANCH RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6700
Country	:	US
Telephone Number	:	561-364-7774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	05/11/2021

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