Provider Demographics
NPI:1255311031
Name:MAHAJAN, RADHA KRISHNA (MD)
Entity Type:Individual
Prefix:MR
First Name:RADHA
Middle Name:KRISHNA
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RADHA
Other - Middle Name:KRISHNA
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2521 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3093
Mailing Address - Country:US
Mailing Address - Phone:610-539-3221
Mailing Address - Fax:610-539-3222
Practice Address - Street 1:2521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-3093
Practice Address - Country:US
Practice Address - Phone:610-539-3221
Practice Address - Fax:610-539-3222
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020142E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0599136Medicaid
060296Medicare ID - Type Unspecified
PAB34614Medicare UPIN