MEDICARE: DR. SEJAL G MATTU 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	207R00000X	Internal Medicine Physician	D0052139	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2167135	OTHER	AETNA HMO
2	74841805	OTHER	BCBS
3	0001	OTHER	BCBS
4	32483	OTHER	KAISER
5	5504586	OTHER	AETNA PPO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	282075	OTHER	MAMSI
8	201233200	OTHER	FEDERAL WORKMANS COMP

General Provider Information

NPI Number	:	1538152004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEJAL G MATTU MD

Provider Business Mailing Address
First Line	:	2401 BRANDERMILL BLVD. SUITE 220
Second Line	:
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1692
Country	:	US
Telephone Number	:	410-451-7214
Fax Number	:	410-451-7218

Provider Business Practice Location Address
First Line	:	2401 BRANDERMILL BLVD
Second Line	:	SUITE 220
City	:	GAMBRILLS
State	:	MD
Zip	:	21054-1690
Country	:	US
Telephone Number	:	410-451-7214
Fax Number	:	410-451-7218

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	04/26/2024

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Directions to “ DR. SEJAL G MATTU MD” Practice Location

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