Provider Demographics
NPI:1508844838
Name:MALLIKARJUN, MAHESH RUDRAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:RUDRAPPA
Last Name:MALLIKARJUN
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-5669
Mailing Address - Country:US
Mailing Address - Phone:740-264-9610
Mailing Address - Fax:740-266-7004
Practice Address - Street 1:4000 JOHNSON RD
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2300
Practice Address - Country:US
Practice Address - Phone:740-264-9610
Practice Address - Fax:740-264-7004
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-085208207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2520123Medicaid
WV3810001008Medicaid
OH2520123Medicaid
WV3810001008Medicaid