Provider Demographics
NPI:1114921053
Name:MATHUR, SANJOG KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SANJOG
Middle Name:KUMAR
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CHARTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3631
Mailing Address - Country:US
Mailing Address - Phone:410-992-7800
Mailing Address - Fax:410-720-2190
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:STE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3631
Practice Address - Country:US
Practice Address - Phone:410-992-7800
Practice Address - Fax:410-730-2190
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47086207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD579L918CMedicare ID - Type Unspecified
MDG56791Medicare UPIN