Provider Demographics
NPI:1053399063
Name:MAHAJAN, SUBHASH C (MD)
Entity type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:C
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7215 OLD OAK BLVD
Mailing Address - Street 2:A312
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3340
Mailing Address - Country:US
Mailing Address - Phone:440-816-2733
Mailing Address - Fax:440-816-5436
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:A312
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3340
Practice Address - Country:US
Practice Address - Phone:440-816-2733
Practice Address - Fax:440-816-5436
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2009-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35040794207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0341802Medicaid
OH0341802Medicaid
OH9266071Medicare PIN