Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 0101230340 | VA |
Y | 207RR0500X | Rheumatology | 37475 | AZ |
NPI | 1083727333 |
---|---|
Provider Name | Dr. Vijayabhanu Mahadevan |
First Address | Surprise, AZ 85378-3703 |
Second Address | Surprise, AZ 85378-3703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 17/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260994 | (05) | AZ |
G95304 | (02) | |
G95304 | (02) | AZ |