Provider Demographics
NPI:1043548464
Name:NALIN MATHUR MD PA
Entity type:Organization
Organization Name:NALIN MATHUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:301-638-2733
Mailing Address - Street 1:2802 HOLLAND CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3116
Mailing Address - Country:US
Mailing Address - Phone:301-638-2733
Mailing Address - Fax:301-638-3377
Practice Address - Street 1:11855 HOLLY LN STE 107
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3114
Practice Address - Country:US
Practice Address - Phone:301-638-2733
Practice Address - Fax:301-638-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty