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1861421521 NPI number — JEEVAN MATHURA JR. MD

NPI Number: 1861421521
Health Care Provider/Practitioner: JEEVAN MATHURA JR. MD

Information about “1861421521” NPI (JEEVAN MATHURA JR. MD) exists in 1861421521 in HTML format HTML  |  1861421521 in plain Text format TXT  |  1861421521 in PDF (Portable Document Format) PDF  |  1861421521 in an XML format XML  formats.

NPI Number : 1861421521 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861421521",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATHURA",
    "FirstName": "JEEVAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1160 VARNUM ST NE",
    "SecondLineMailingAddress": "STE 208",
    "MailingAddressCityName": "WASHINGTON",
    "MailingAddressStateName": "DC",
    "MailingAddressPostalCode": "20017-2107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "202-399-1616",
    "MailingAddressFaxNumber": "866-265-5635",
    "FirstLinePracticeLocationAddress": "1160 VARNUM ST NE STE 208",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WASHINGTON",
    "PracticeLocationAddressStateName": "DC",
    "PracticeLocationAddressPostalCode": "20017-2103",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "202-399-1616",
    "PracticeLocationAddressFaxNumber": "866-265-5635",
    "EnumerationDate": "07/02/2006",
    "LastUpdateDate": "12/06/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "036107224",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "MD036329",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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