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General NPI Number Information
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NPI Number | 1366505372
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Entity Type | Organization
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Legal Business Name | JANARDHANA MAHADEVA
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 174 MAIN STREET
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City | DELHI
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State | NY
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Zip | 13753
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Country | US
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Telephone | 607-746-6467
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Fax | 607-746-6465
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Provider Business Mailing Address
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Address Line | 174 MAIN STREET
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City | DELHI
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State | NY
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Zip | 13753
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Country | US
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Telephone | 607-746-6467
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Fax | 607-746-6465
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANARDHANA MAHADEVA
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Credential | MD
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Telephone | 607-746-6467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 121637
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License Number State | NY
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