MEDICARE: PUSHPA MAHALINGAM 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	14576	AZ

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	:	1780664193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUSHPA MAHALINGAM MD

Provider Business Mailing Address
First Line	:	3805 E BELL RD
Second Line	:	STE. 2100
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2105
Country	:	US
Telephone Number	:	602-404-5200
Fax Number	:	602-404-5228

Provider Business Practice Location Address
First Line	:	3805 E BELL RD
Second Line	:	STE. 2100
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2105
Country	:	US
Telephone Number	:	602-404-5200
Fax Number	:	602-404-5228

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	12/29/2011

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Directions to “ PUSHPA MAHALINGAM MD” Practice Location

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