Provider Demographics
NPI:1528226495
Name:CHAITANYA N. MAHIDA M.D., INC
Entity Type:Organization
Organization Name:CHAITANYA N. MAHIDA M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-847-0314
Mailing Address - Street 1:1425 W H ST
Mailing Address - Street 2:SUITE 380
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3588
Mailing Address - Country:US
Mailing Address - Phone:209-847-0314
Mailing Address - Fax:
Practice Address - Street 1:1425 W H ST
Practice Address - Street 2:SUITE 380
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3588
Practice Address - Country:US
Practice Address - Phone:209-847-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty