Healthcare Provider Details

I. General information

NPI: 1235583311
Provider Name (Legal Business Name): JEEVAN MATHEW PUTHIAMADATHIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BLDG 10, RM B2L312
BETHESDA MD
20892
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD046921
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: