Provider Demographics
NPI:1952342313
Name:SANDIP MATHUR, M.D., P.A.
Entity type:Organization
Organization Name:SANDIP MATHUR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDIP
Authorized Official - Middle Name:V
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:325-692-3777
Mailing Address - Street 1:PO BOX 5496
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5496
Mailing Address - Country:US
Mailing Address - Phone:325-692-3777
Mailing Address - Fax:325-695-2659
Practice Address - Street 1:6300 REGIONAL PLZ
Practice Address - Street 2:SUITE 820
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5251
Practice Address - Country:US
Practice Address - Phone:325-692-3777
Practice Address - Fax:325-695-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166495501Medicaid
TX0088PYOtherBCBS
TX166495501Medicaid
TXG09672Medicare UPIN