Provider Demographics
NPI:1952310880
Name:RITA MATHUR
Entity Type:Organization
Organization Name:RITA MATHUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ESAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-780-1980
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-7094
Mailing Address - Country:US
Mailing Address - Phone:410-780-1980
Mailing Address - Fax:410-780-1984
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:STE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-780-1980
Practice Address - Fax:410-780-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD645RMedicare ID - Type Unspecified
MDH41396Medicare UPIN