Provider Demographics
NPI:1578619375
Name:MATHUR, PURAN PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PURAN
Middle Name:PRASAD
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11520 SWAINS LOCK TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1200
Mailing Address - Country:US
Mailing Address - Phone:301-765-9003
Mailing Address - Fax:301-765-9003
Practice Address - Street 1:2401 RESEARCH BLVD STE 350
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6211
Practice Address - Country:US
Practice Address - Phone:301-424-8317
Practice Address - Fax:301-330-6985
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD35941207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD202381400Medicaid
DC641274Medicare PIN
MD202381400Medicaid