Provider Demographics
NPI:1679777544
Name:MATTHEWS, JOSELIN ANANDAM (MD)
Entity type:Individual
Prefix:
First Name:JOSELIN
Middle Name:ANANDAM
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9103
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 303
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1603
Practice Address - Country:US
Practice Address - Phone:469-307-5265
Practice Address - Fax:833-645-0188
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1529208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0017667OtherINSTITUTIONAL PERMIT