Provider Demographics
NPI:1447577408
Name:MATHEW, NEETHU M (MD)
Entity type:Individual
Prefix:
First Name:NEETHU
Middle Name:M
Last Name:MATHEW
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 1:501 WOODBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7060
Mailing Address - Country:US
Mailing Address - Phone:972-442-2300
Mailing Address - Fax:
Practice Address - Street 1:501 WOODBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7060
Practice Address - Country:US
Practice Address - Phone:972-442-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics