Healthcare Provider Details

I. General information

NPI: 1497844682
Provider Name (Legal Business Name): SATISH KUMAR MAHAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

5801 BREMO RD
RICHMOND VA
23226-1907
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8222
  • Fax: 804-281-8007
Mailing address:
  • Phone: 804-281-8222
  • Fax: 804-281-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101222261
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101222261
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: