MEDICARE: MR. MARIGANGAIAH MAHADEV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A45109	CA
2	207QA0505X	Adult Medicine Physician	A45109	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245264902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIGANGAIAH MAHADEV MD

Provider Business Mailing Address
First Line	:	125 CHAPARRAL COURT
Second Line	:	SUITE 102
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-998-1941
Fax Number	:	714-998-3472

Provider Business Practice Location Address
First Line	:	125 CHAPARRAL COURT
Second Line	:	SUITE 102
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-998-1941
Fax Number	:	714-998-3472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/13/2011

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