Healthcare Provider Details

I. General information

NPI: 1992864177
Provider Name (Legal Business Name): RAJ PRATAP MATHUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/07/2023
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 211
WASHINGTON DC
20010-2993
US

IV. Provider business mailing address

10218 YEARLING DR
ROCKVILLE MD
20850-3548
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-0149
  • Fax:
Mailing address:
  • Phone: 240-252-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101054105
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0042403
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD19927
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: