MEDICARE: DR. KRISHAN MATHUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	D28352	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	35150501	OTHER	CAREFIRST BC BS
3	3600310	OTHER	UHC
4	4376960	OTHER	AETNA
5	38917	OTHER	MAMSI

General Provider Information

NPI Number	:	1326082884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHAN MATHUR M.D.

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

Provider Business Practice Location Address
First Line	:	3500 OLD WASHINGTON RD
Second Line	:	SUITE 102
City	:	WALDORF
State	:	MD
Zip	:	20602-3224
Country	:	US
Telephone Number	:	301-645-4242
Fax Number	:	301-705-7512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/30/2010

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Directions to “ DR. KRISHAN MATHUR M.D.” Practice Location

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