Healthcare Provider Details

I. General information

NPI: 1962458984
Provider Name (Legal Business Name): PARAG ASHOK MAHATEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7943 MOFFETT RD
SEMMES AL
36575
US

IV. Provider business mailing address

7943 MOFFETT RD
SEMMES AL
36575-5409
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0123
  • Fax: 251-445-3722
Mailing address:
  • Phone: 251-633-0123
  • Fax: 251-445-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23280
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23280
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: