1730459264 NPI number — PURAN P MATHUR, M.D., PC

Table of content: (NPI 1730459264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730459264 NPI number — PURAN P MATHUR, M.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURAN P MATHUR, M.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1730459264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11520 SWAINS LOCK TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-343-7089
Provider Business Mailing Address Fax Number:
301-765-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 RESEARCH BLVD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-330-6985
Provider Business Practice Location Address Fax Number:
301-330-6984
Provider Enumeration Date:
12/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ALOYSIUS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
301-258-1904

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  D35941 , 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: 202381400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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