Provider Demographics
NPI:1578665279
Name:JAPANWALLA, MAHEJABEEN (MD)
Entity Type:Individual
Prefix:
First Name:MAHEJABEEN
Middle Name:
Last Name:JAPANWALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 TAVESHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1269
Mailing Address - Country:US
Mailing Address - Phone:301-469-1626
Mailing Address - Fax:301-767-3940
Practice Address - Street 1:7217 TAVESHIRE WAY
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1269
Practice Address - Country:US
Practice Address - Phone:301-469-1626
Practice Address - Fax:301-767-3940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053754207R00000X, 2085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00424823OtherRAILROAD MEDICARE
MDH427214Medicare ID - Type UnspecifiedMEDICARE
DCFDUVN1Medicare PIN
DCFDX009Medicare PIN
GAP00424823OtherRAILROAD MEDICARE