Provider Demographics
NPI:1255310983
Name:MAHALINGAM, SUDHA B (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUDHA
Middle Name:B
Last Name:MAHALINGAM
Suffix:
Gender:F
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:LOCATION 0883
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0001
Mailing Address - Country:US
Mailing Address - Phone:877-841-5125
Mailing Address - Fax:859-363-4984
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:SUITE G102
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4487
Practice Address - Country:US
Practice Address - Phone:859-363-4886
Practice Address - Fax:859-363-4984
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044562M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481750Medicaid
OHA82287Medicare UPIN
OH0574633Medicare PIN