Healthcare Provider Details

I. General information

NPI: 1134148588
Provider Name (Legal Business Name): DAVID J MATHISON M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW DIVISION OF EMERGENCY MEDICINE
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

10101 EDWARD AVE
BETHESDA MD
20814-2115
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4177
  • Fax:
Mailing address:
  • Phone: 301-742-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-114606
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD036676
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD0067848
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: