Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A53588 | CA |
N | 111NI0900X | Internist | A53588 | CA |
N | 2081P2900X | Pain Medicine | A53588 | CA |
NPI | 1033154893 |
---|---|
Provider Name | Dr. Suresh Mahawar |
First Address | Fremont, CA 94538-1460 |
Second Address | Fremont, CA 94538-1460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A535880 | (05) | CA |
F09558 | (02) | CA |