Provider Demographics
NPI:1003908047
Name:MAHAJAN, SURESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:KUMAR
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:C101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-2789
Mailing Address - Fax:440-816-2811
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:C101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-2789
Practice Address - Fax:440-816-2811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058230207RG0100X
OH35-05-8230207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198263Medicaid
OH0198263Medicaid
OHMA756422Medicare PIN