Provider Demographics
NPI:1578752457
Name:BABU, MAYUKH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYUKH
Middle Name:
Last Name:BABU
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 1:25875 SCIENCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7304
Mailing Address - Country:US
Mailing Address - Phone:216-448-0218
Mailing Address - Fax:
Practice Address - Street 1:25875 SCIENCE PARK DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7304
Practice Address - Country:US
Practice Address - Phone:216-448-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35-0909702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00646980OtherRAILROAD MEDICARE
OH2842311Medicaid
OH4249122Medicare UPIN
OHP00646980OtherRAILROAD MEDICARE