Provider Demographics
NPI:1538113550
Name:MAHADEVAN, HARIHARA IYER (MD)
Entity Type:Individual
Prefix:
First Name:HARIHARA
Middle Name:IYER
Last Name:MAHADEVAN
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 1:100 EMANCIPATION DR
Mailing Address - Street 2:IMAGING SVC 114 VA MEDICAL CENTER
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-728-3471
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:IMAGING SVC 114 VA MEDICAL CENTER
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-728-3471
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010283952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology