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NPI Code Detail

MEDICARE: DR. MUKTAK MATHUR M.D.

MEDICARE: DR. MUKTAK 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
1207Q00000XFamily Medicine Physician001794GA
2207Q00000XFamily Medicine Physician0101252128VA

General Provider Information

NPI Number : 1952558678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MUKTAK MATHUR M.D.
Provider Business Mailing Address
First Line : 12125 ELNORA LN
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23059-7091
Country : US
Telephone Number : 770-968-6460
Fax Number :
Provider Business Practice Location Address
First Line : 1000 CORPORATE CENTER DR STE 200
Second Line :
City : MORROW
State : GA
Zip : 30260-4129
Country : US
Telephone Number : 770-968-6460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2008
Last Update Date : 08/08/2022

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