Healthcare Provider Details

I. General information

NPI: 1639386840
Provider Name (Legal Business Name): ANSHU MAHAJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 HARBOUR VIEW BLVD STE 200
SUFFOLK VA
23435-3797
US

IV. Provider business mailing address

5839 HARBOUR VIEW BLVD STE 200
SUFFOLK VA
23435-3797
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax: 757-483-2203
Mailing address:
  • Phone: 757-483-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101246719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: