Provider Demographics
NPI:1497024988
Name:MAHENDRA MAHATMA, M.D., P.A.
Entity Type:Organization
Organization Name:MAHENDRA MAHATMA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-331-1590
Mailing Address - Street 1:6500 SIERRA DR
Mailing Address - Street 2:#170
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2480
Mailing Address - Country:US
Mailing Address - Phone:972-331-1590
Mailing Address - Fax:972-570-0779
Practice Address - Street 1:6500 SIERRA DR
Practice Address - Street 2:#170
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2480
Practice Address - Country:US
Practice Address - Phone:972-331-1590
Practice Address - Fax:972-570-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty