Provider Demographics
NPI:1891791935
Name:MATHUR, NALIN (MD PA)
Entity Type:Individual
Prefix:
First Name:NALIN
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7436
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-0436
Mailing Address - Country:US
Mailing Address - Phone:301-638-2733
Mailing Address - Fax:301-638-3377
Practice Address - Street 1:11855 HOLLY LANE
Practice Address - Street 2:#107
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3114
Practice Address - Country:US
Practice Address - Phone:301-638-2733
Practice Address - Fax:301-638-3377
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD504RMedicare ID - Type UnspecifiedSOUTHERN MD
MD490881Medicare ID - Type UnspecifiedP.G. COUNTY
MDG59991Medicare UPIN