Provider Demographics
NPI:1437395670
Name:MAHESH R DAVE MD-NALINI M DAVE MD & ASSOCIATES
Entity Type:Organization
Organization Name:MAHESH R DAVE MD-NALINI M DAVE MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-5600
Mailing Address - Street 1:1201D BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5223
Mailing Address - Country:US
Mailing Address - Phone:979-776-5600
Mailing Address - Fax:979-776-6280
Practice Address - Street 1:1201D BRIARCREST DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5223
Practice Address - Country:US
Practice Address - Phone:979-776-5600
Practice Address - Fax:979-776-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8457302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099470901Medicaid
TX110618901Medicaid
TXC15027Medicare UPIN
TXC15028Medicare UPIN
TX00NL62Medicare PIN
TX00MH79Medicare PIN