Provider Demographics
NPI:1861421521
Name:MATHURA, JEEVAN JR (MD)
Entity type:Individual
Prefix:
First Name:JEEVAN
Middle Name:
Last Name:MATHURA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:STE 208
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-399-1616
Mailing Address - Fax:866-265-5635
Practice Address - Street 1:1160 VARNUM ST NE STE 208
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2103
Practice Address - Country:US
Practice Address - Phone:202-399-1616
Practice Address - Fax:866-265-5635
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107224207W00000X
DCMD036329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology