Basic Information
| Provider Information | |||||||||
| NPI: | 1730172305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHUR | ||||||||
| FirstName: | VINITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 BRIARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371155127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158683131 | ||||||||
| FaxNumber: | 6158683192 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 BRIARVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371155127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158683131 | ||||||||
| FaxNumber: | 6158683192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 04/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MD0000043396 | TN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 200500221 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 5900266 | 05 | NC | MEDICAID | E4403-26290 | 01 | NC | MEDCOST | OTHER | 046JM | 01 | NC | BCBS NC | OTHER | 130I227776 | 01 | TN | MEDICARE PTAN | OTHER | 3721566 | 01 | TN | GROUP PTAN | OTHER |