1568604932 NPI number — DR. SHEMA JOSEPH MATHEW M.D.

Table of content: DR. SHEMA JOSEPH MATHEW M.D. (NPI 1568604932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568604932 NPI number — DR. SHEMA JOSEPH MATHEW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEW
Provider First Name:
SHEMA
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1568604932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16404 SIGNATURE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20853-3287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-538-0869
Provider Business Mailing Address Fax Number:
301-774-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10301 GEORGIA AVE
Provider Second Line Business Practice Location Address:
SUITE #303
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-538-0869
Provider Business Practice Location Address Fax Number:
301-774-5365
Provider Enumeration Date:
04/01/2009

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: 207T00000X , with the licence number:  D0045362 , 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: 417119500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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