MEDICARE: RAKESH K MATHUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0039170	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326013038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAKESH K MATHUR M.D.

Provider Business Mailing Address
First Line	:	2112 BEL AIR RD
Second Line	:	SUITE 1
City	:	FALLSTON
State	:	MD
Zip	:	21047-2786
Country	:	US
Telephone Number	:	410-877-8550
Fax Number	:	410-877-8551

Provider Business Practice Location Address
First Line	:	2112 BEL AIR RD
Second Line	:	SUITE 1
City	:	FALLSTON
State	:	MD
Zip	:	21047
Country	:	US
Telephone Number	:	410-877-8550
Fax Number	:	410-877-8551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/29/2013

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