Provider Demographics
NPI:1467898817
Name:JACOB MATHAI, ASHWIN (MD)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:
Last Name:JACOB MATHAI
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 1:1100 ALABAMA AVE SE RM 238
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4542
Mailing Address - Country:US
Mailing Address - Phone:202-255-8422
Mailing Address - Fax:
Practice Address - Street 1:35 K ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4216
Practice Address - Country:US
Practice Address - Phone:204-442-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2845542084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry