Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD25651 | DC |
NPI | 1063506343 |
---|---|
Provider Name | Jeevan Mathura |
First Address | Washington, DC 20036-4802 |
Second Address | Washington, DC 20002-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |