Individual
DR. PRAKASH JOEL MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
3400 SPRUCE ST, PHILDELPHIA, PA 19104-4206
(215) 662-2096
(215) 349-5895
Mailing address
3400 SPRUCE ST, PHILDELPHIA, PA 19104-4206
(215) 662-2096
(215) 349-5895
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
25MA11102600
NJ
208200000X
Plastic Surgery Physician
Primary
MD473789
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0856983
—
NJ
Enumeration date
08/12/2012
Last updated
11/04/2024
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