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General NPI Number Information
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NPI Number | 1801980222
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Entity Type | Organization
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Legal Business Name | MANOJ MATHUR MD PA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 110 HOSPITAL RD SUITE 305
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678
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Country | US
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Telephone | 410-535-1451
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Fax |
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Provider Business Mailing Address
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Address Line | P. O. BOX 209
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City | DUNKIRK
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State | MD
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Zip | 20678
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Country | US
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Telephone | 410-535-1451
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANOJ MATHUR
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Credential | M.D.
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Telephone | 410-535-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0061947
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License Number State | MD
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