Provider Demographics
NPI:1992730568
Name:MATHUR, MANOJ (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:CALVERT INTERNAL MEDICINE GROUP, PA
Mailing Address - Street 2:985 PRINCE FREDERICK BLVD, STE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3042
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:443-432-3683
Practice Address - Street 1:3995 OLD TOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-3041
Practice Address - Country:US
Practice Address - Phone:410-535-1451
Practice Address - Fax:410-535-9620
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-12-27
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Provider Licenses
StateLicense IDTaxonomies
MDD0061947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406057100Medicaid
I21813Medicare UPIN
MD142N099GMedicare PIN
MD406057100Medicaid