Provider Demographics
NPI:1609015767
Name:SHEMA J. MATHEW, M.D. LLC
Entity Type:Organization
Organization Name:SHEMA J. MATHEW, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:301-538-0869
Mailing Address - Street 1:16404 SIGNATURE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3287
Mailing Address - Country:US
Mailing Address - Phone:301-538-0869
Mailing Address - Fax:301-774-5365
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-538-0869
Practice Address - Fax:301-774-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417119500Medicaid