Provider Demographics
NPI:1720040835
Name:MAHADEVIA, GEETA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GEETA
Middle Name:
Last Name:MAHADEVIA
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 1:3319 SPRING ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2125
Mailing Address - Country:US
Mailing Address - Phone:563-324-0696
Mailing Address - Fax:563-324-0697
Practice Address - Street 1:3319 SPRING ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2125
Practice Address - Country:US
Practice Address - Phone:563-324-0696
Practice Address - Fax:563-324-0697
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA252812083X0100X
IL2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA66160Medicare UPIN
IAI12022Medicare ID - Type Unspecified
ILK04390Medicare ID - Type Unspecified