Healthcare Provider Details

I. General information

NPI: 1780664193
Provider Name (Legal Business Name): PUSHPA MAHALINGAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE. 2100
PHOENIX AZ
85032-2105
US

IV. Provider business mailing address

3805 E BELL RD STE. 2100
PHOENIX AZ
85032-2105
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-5200
  • Fax: 602-404-5228
Mailing address:
  • Phone: 602-404-5200
  • Fax: 602-404-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14576
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: