Organization
ANITA MATHUR MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETTE TARNOWSKI (BILLING MANAGER)
(386) 774-7337
Entity
Organization
Contact information
Practice address
999 S VOLUSIA AVE STE B, ORANGE CITY, FL 32763-6564
(386) 774-7337
Mailing address
999 S VOLUSIA AVE STE B, ORANGE CITY, FL 32763-6564
(386) 774-7337
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME67495
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37584
BCBS
—
05
—
379425300
—
FL
Enumeration date
02/12/2015
Last updated
02/12/2015
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