Provider Demographics
NPI:1902074644
Name:MATHEW, GEETHA REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:REBECCA
Last Name:MATHEW
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 1:2 E GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2938
Mailing Address - Country:US
Mailing Address - Phone:703-535-5568
Mailing Address - Fax:703-299-1794
Practice Address - Street 1:2 E GLEBE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2938
Practice Address - Country:US
Practice Address - Phone:703-535-5568
Practice Address - Fax:703-299-1794
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73656207Q00000X
VA0101248386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine