Provider Demographics
NPI:1841432622
Name:RAKESH K MATHUR MD LLC
Entity Type:Organization
Organization Name:RAKESH K MATHUR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-877-8550
Mailing Address - Street 1:2112 BEL AIR RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2786
Mailing Address - Country:US
Mailing Address - Phone:410-877-8550
Mailing Address - Fax:410-877-8551
Practice Address - Street 1:2112 BEL AIR RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2786
Practice Address - Country:US
Practice Address - Phone:410-877-8550
Practice Address - Fax:410-877-8551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAKESH K MATHUR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039170208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty