1952346066 NPI number — NAVDEEP MATHUR MD

Table of content: NAVDEEP MATHUR MD (NPI 1952346066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952346066 NPI number — NAVDEEP MATHUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHUR
Provider First Name:
NAVDEEP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952346066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8428 DORSEY CIR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20110-8302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-379-8827
Provider Business Mailing Address Fax Number:
888-224-4936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8428 DORSEY CIR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-8302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-379-8827
Provider Business Practice Location Address Fax Number:
888-224-4936
Provider Enumeration Date:
06/20/2006

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:  0101240433 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1972892065 . This is a "COPORATE NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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