1326082884 NPI number — DR. KRISHAN MATHUR M.D.

Table of content: DR. KRISHAN MATHUR M.D. (NPI 1326082884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326082884 NPI number — DR. KRISHAN MATHUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHUR
Provider First Name:
KRISHAN
Provider Middle Name:
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:
1326082884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-645-4242
Provider Business Mailing Address Fax Number:
301-705-7512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 OLD WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-645-4242
Provider Business Practice Location Address Fax Number:
301-705-7512
Provider Enumeration Date:
06/15/2006

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: 207RH0003X , with the licence number:  D28352 , 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)

  • Identifier: 301331600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35150501 . This is a "CAREFIRST BC BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3600310 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4376960 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38917 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".