Individual
DR. MARY CYRIAC MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
320 WHITTINGTON PKWY, SUITE 301, LOUISVILLE, KY 40222-4928
(502) 625-5584
(502) 426-2264
Mailing address
320 WHITTINGTON PKWY, SUITE 301, LOUISVILLE, KY 40222-4928
(502) 625-5584
(502) 426-2264
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
42605
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3748210000
PASSPORT ADVANTAGE
KY
01
—
50026504
PASSPORT
KY
05
—
7100095000
—
KY
Enumeration date
05/18/2006
Last updated
03/22/2016
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