Provider Demographics
NPI:1083719280
Name:MAHESH, KENKRE G (MD)
Entity Type:Individual
Prefix:
First Name:KENKRE
Middle Name:G
Last Name:MAHESH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:28 STURDY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3148
Mailing Address - Country:US
Mailing Address - Phone:508-226-7788
Mailing Address - Fax:508-226-7922
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2248
Practice Address - Country:US
Practice Address - Phone:508-222-8444
Practice Address - Fax:508-226-3713
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59809208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724974Medicaid
MA9724974Medicaid
MAB84486Medicare UPIN