Provider Demographics
NPI:1053310227
Name:MAHANT, PADMA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:R
Last Name:MAHANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:PADMA
Other - Middle Name:R
Other - Last Name:RAJASEKHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4530 E MUIRWOOD DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7639
Mailing Address - Country:US
Mailing Address - Phone:480-961-2365
Mailing Address - Fax:480-961-2382
Practice Address - Street 1:4530 E MUIRWOOD DR
Practice Address - Street 2:SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7639
Practice Address - Country:US
Practice Address - Phone:480-961-2365
Practice Address - Fax:480-961-2382
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ278442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76535Medicare PIN
AZH09018Medicare UPIN