1295769834 NPI number — DR. MUKESH N MATHUR M.D.

Table of content: DR. MUKESH N MATHUR M.D. (NPI 1295769834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295769834 NPI number — DR. MUKESH N MATHUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHUR
Provider First Name:
MUKESH
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295769834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALVERT INTERNAL MEDICINE GROUP, P.A.
Provider Second Line Business Mailing Address:
985 PRINCE FREDERICK BLVD., STE 201
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-3042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-2005
Provider Business Mailing Address Fax Number:
443-432-3683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3995 OLD TOWN RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HUNTINGTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20639-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-1451
Provider Business Practice Location Address Fax Number:
410-535-9620
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D-0025435 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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