Provider Demographics
NPI:1730172305
Name:MATHUR, VINITA (MD)
Entity type:Individual
Prefix:DR
First Name:VINITA
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 1:350 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:787-654-8724
Mailing Address - Fax:475-751-0455
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:787-654-8724
Practice Address - Fax:475-751-0455
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500221207ZP0102X
TNMD0000043396207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN130I227776OtherMEDICARE PTAN
NCE4403-26290OtherMEDCOST
NC5900266Medicaid
TN3721566OtherGROUP PTAN
NC046JMOtherBCBS NC
TN3721566OtherGROUP PTAN