Healthcare Provider Details

I. General information

NPI: 1578619375
Provider Name (Legal Business Name): PURAN PRASAD MATHUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RESEARCH BLVD STE 350
ROCKVILLE MD
20850-6211
US

IV. Provider business mailing address

11520 SWAINS LOCK TER
POTOMAC MD
20854-1200
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-8317
  • Fax: 301-330-6985
Mailing address:
  • Phone: 301-765-9003
  • Fax: 301-765-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD35941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: