Provider Demographics
NPI:1376688556
Name:MAHADEVAN, RAMASAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMASAMY
Middle Name:
Last Name:MAHADEVAN
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 1:44900 60TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7618
Mailing Address - Country:US
Mailing Address - Phone:661-948-8581
Mailing Address - Fax:661-945-8474
Practice Address - Street 1:44900 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7618
Practice Address - Country:US
Practice Address - Phone:661-948-8581
Practice Address - Fax:661-945-8474
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA031542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB13062Medicare UPIN
CAWA31542CMedicare ID - Type Unspecified