Provider Demographics
NPI:1639189616
Name:MAHIDA, CHAITANYA NATVARSINH (MD)
Entity Type:Individual
Prefix:MR
First Name:CHAITANYA
Middle Name:NATVARSINH
Last Name:MAHIDA
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 1:1425 WEST H ST., STE 380
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3531
Mailing Address - Country:US
Mailing Address - Phone:209-847-0314
Mailing Address - Fax:209-845-1604
Practice Address - Street 1:1425 WEST H ST. #380
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3531
Practice Address - Country:US
Practice Address - Phone:209-847-0314
Practice Address - Fax:209-845-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A482750Medicaid
CA00A482750Medicare ID - Type Unspecified
CAE95053Medicare UPIN