Provider Demographics
NPI:1972889913
Name:MATHUR, RAMESH
Entity Type:Individual
Prefix:MR
First Name:RAMESH
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2461
Mailing Address - Country:US
Mailing Address - Phone:301-352-2345
Mailing Address - Fax:301-358-3841
Practice Address - Street 1:12715 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2461
Practice Address - Country:US
Practice Address - Phone:301-352-2345
Practice Address - Fax:301-358-3841
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3081P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health