Provider Demographics
NPI:1497784300
Name:MAHAJAN, VINIT BHARATI (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:VINIT
Middle Name:BHARATI
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7999 GATEWAY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1197
Mailing Address - Country:US
Mailing Address - Phone:888-924-1036
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36642207W00000X
CAA83613207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0730002Medicaid
IA20027OtherWELLMARK BCBS
IA20027OtherWELLMARK BCBS
IAP00364826Medicare PIN
I59170Medicare UPIN