Provider Demographics
NPI:1538145958
Name:BANDARA, MAHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:
Last Name:BANDARA
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-286-1327
Practice Address - Street 1:9 HEALTHCARE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9449
Practice Address - Country:US
Practice Address - Phone:207-283-6408
Practice Address - Fax:207-286-1327
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23390207R00000X
MA227154207R00000X
ME017725208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433555299Medicaid
NH30208315Medicaid
NH30208315Medicaid