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General NPI Number Information
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NPI Number | 1235583311
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Entity Type | Individual
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Provider Name | JEEVAN MATHEW PUTHIAMADATHIL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 10 CENTER DR BLDG 10, RM B2L312
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City | BETHESDA
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State | MD
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Zip | 20892
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Country | US
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Telephone | 301-496-4916
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD046921
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License Number State | DC
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