Provider Demographics
NPI:1639114606
Name:BANMAHA PC
Entity Type:Organization
Organization Name:BANMAHA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BALKISSOON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHARAJH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-9715
Mailing Address - Street 1:1015 FRANKLIN ST
Mailing Address - Street 2:LEVEL A
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4155
Practice Address - Country:US
Practice Address - Phone:814-536-9715
Practice Address - Fax:814-539-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051194L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019472520002Medicaid
PA0019472520002Medicaid
PA0019472520002Medicaid