Healthcare Provider Details

I. General information

NPI: 1073751616
Provider Name (Legal Business Name): SANTOSH MAHARJAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N HARRISON ST
WARSAW IN
46580-3163
US

IV. Provider business mailing address

3201 E CENTER STREET EXT ATTN: ANNE LAWSON - CREDENTIALING
WARSAW IN
46582-3907
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-7169
  • Fax: 574-269-3995
Mailing address:
  • Phone: 574-267-1700
  • Fax: 574-267-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number237329
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01070474A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: