Provider Demographics
NPI:1184156010
Name:MATHEW, ANTONY (MD)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WOODLAWN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3225
Mailing Address - Country:US
Mailing Address - Phone:239-822-8333
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:925-225-5837
Practice Address - Fax:925-225-5838
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169892207P00000X
390200000X
FLME151315207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program