Provider Demographics
NPI:1609459429
Name:MAHAT, SANJAY (MBBS)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:MAHAT
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E MARKET STREET, 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:330-675-5714
Mailing Address - Fax:330-675-5721
Practice Address - Street 1:1350 E MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-675-5714
Practice Address - Fax:330-675-5721
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program