Individual
KEVIN MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 HOBART ST, UTICA, NY 13501-4308
(315) 798-1149
(315) 734-3565
Mailing address
120 HOBART ST, UTICA, NY 13501-4308
(315) 798-1149
(315) 734-3565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A166847
NY
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
A166847-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01037645
—
NY
01
—
080177842
RRMCR
NY
Enumeration date
10/27/2005
Last updated
06/13/2012
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