Healthcare Provider Details

I. General information

NPI: 1346694668
Provider Name (Legal Business Name): MARIAM MATHAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JEFFERSON PLZ STE 320
ROCKVILLE MD
20852-1197
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 301-315-2198
  • Fax: 301-315-2187
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-530-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD048093
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101268948
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0089331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: