Provider Demographics
NPI:1538152004
Name:MATTU, SEJAL G (MD)
Entity type:Individual
Prefix:DR
First Name:SEJAL
Middle Name:G
Last Name:MATTU
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 1:2401 BRANDERMILL BLVD. SUITE 220
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1692
Mailing Address - Country:US
Mailing Address - Phone:410-451-7214
Mailing Address - Fax:410-451-7218
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-451-7214
Practice Address - Fax:410-451-7218
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167135OtherAETNA HMO
74841805OtherBCBS
0001OtherBCBS
32483OtherKAISER
5504586OtherAETNA PPO
MD942161102Medicaid
282075OtherMAMSI
201233200OtherFEDERAL WORKMANS COMP
0001OtherBCBS
282075OtherMAMSI
MD942161102Medicaid