Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 35-05-8230 | OH |
N | 207RG0100X | Gastroenterologist | 35058230 | OH |
NPI | 1003908047 |
---|---|
Provider Name | Suresh Kumar Mahajan |
First Address | Cleveland, OH 44130-3329 |
Second Address | Cleveland, OH 44130-3329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0198263 | (05) | OH |
F00720 | (02) | OH |