Provider Demographics
NPI:1629277165
Name:KRISHAN M MATHUR MD
Entity Type:Organization
Organization Name:KRISHAN M MATHUR MD
Other - Org Name:CAMBRIDGE ONCOLOGY AND INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-645-4242
Mailing Address - Street 1:PO BOX 2729
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-2729
Mailing Address - Country:US
Mailing Address - Phone:301-645-4242
Mailing Address - Fax:301-705-7512
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-645-4242
Practice Address - Fax:301-705-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-14
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5937KMOtherCAREFIRST BC BS
DC9424OtherCAREFIRST BC BS
MD171001Medicare PIN