Basic Information
| Provider Information | |||||||||
| NPI: | 1952384356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHUR | ||||||||
| FirstName: | GEETA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 PICCARD DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019217900 | ||||||||
| FaxNumber: | 3019217915 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PKWY | ||||||||
| Address2: | RESTON HOSPITAL CENTER | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201903219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036899037 | ||||||||
| FaxNumber: | 7036899109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101230968 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | 0101230968 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005867576 | 05 | VA | MEDICAID |