Provider Demographics
NPI:1033154893
Name:MAHAWAR, SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:
Last Name:MAHAWAR
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 1:3550 MOWRY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1460
Mailing Address - Country:US
Mailing Address - Phone:510-797-5500
Mailing Address - Fax:510-797-5507
Practice Address - Street 1:3550 MOWRY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1460
Practice Address - Country:US
Practice Address - Phone:510-797-5500
Practice Address - Fax:510-797-5507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53588207R00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A535880Medicaid
CA00A535880Medicare ID - Type Unspecified
CA00A535880Medicaid