Healthcare Provider Details

I. General information

NPI: 1295769834
Provider Name (Legal Business Name): MUKESH N MATHUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 OLD TOWN RD SUITE 202
HUNTINGTOWN MD
20639-3041
US

IV. Provider business mailing address

CALVERT INTERNAL MEDICINE GROUP, P.A. 985 PRINCE FREDERICK BLVD., STE 201
PRINCE FREDERICK MD
20678-3042
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-1451
  • Fax: 410-535-9620
Mailing address:
  • Phone: 410-535-2005
  • Fax: 443-432-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD-0025435
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: