Provider Demographics
NPI:1487751491
Name:MATHUR, PROMILA (MD)
Entity type:Individual
Prefix:
First Name:PROMILA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SOUTH ST
Mailing Address - Street 2:#100
Mailing Address - City:NORTHBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-393-2999
Mailing Address - Fax:508-393-3243
Practice Address - Street 1:27 SOUTH ST
Practice Address - Street 2:#100
Practice Address - City:NORTHBORO
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-2999
Practice Address - Fax:508-393-3243
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44512207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology