Provider Demographics
NPI:1437176187
Name:MAHATMA, MAHENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:
Last Name:MAHATMA
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 1:6500 SIERRA DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2480
Mailing Address - Country:US
Mailing Address - Phone:972-570-5884
Mailing Address - Fax:972-570-0779
Practice Address - Street 1:6500 SIERRA DR
Practice Address - Street 2:SUITE 170
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2480
Practice Address - Country:US
Practice Address - Phone:972-570-5884
Practice Address - Fax:972-570-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8739207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098320701Medicaid
TX098320701Medicaid
TXB63367Medicare UPIN