MEDICARE: DR. ANANDRAJ MATTAI MD

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	2084P0800X	Psychiatry Physician	D67668	MD

General Provider Information

NPI Number	:	1407070881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANANDRAJ MATTAI MD

Provider Business Mailing Address
First Line	:	9256 BENDIX RD STE 200B
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	319-331-3653
Fax Number	:

Provider Business Practice Location Address
First Line	:	9256 BENDIX RD STE 200B
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	443-542-0773
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	05/10/2024

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