Provider Demographics
NPI:1952327884
Name:MATHEWS, SHOBA (MD)
Entity Type:Individual
Prefix:
First Name:SHOBA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD
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 628
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-0628
Mailing Address - Country:US
Mailing Address - Phone:301-855-1302
Mailing Address - Fax:301-855-9115
Practice Address - Street 1:#7 POST OFFICE RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20604-0628
Practice Address - Country:US
Practice Address - Phone:301-855-1302
Practice Address - Fax:301-855-9115
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0381792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
071612Medicare ID - Type Unspecified
E35553Medicare UPIN