Healthcare Provider Details

I. General information

NPI: 1437176187
Provider Name (Legal Business Name): MAHENDRA MAHATMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 SIERRA DR SUITE 170
IRVING TX
75039-2480
US

IV. Provider business mailing address

6500 SIERRA DR SUITE 170
IRVING TX
75039-2480
US

V. Phone/Fax

Practice location:
  • Phone: 972-570-5884
  • Fax: 972-570-0779
Mailing address:
  • Phone: 972-570-5884
  • Fax: 972-570-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberH8739
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: