Provider Demographics
NPI:1780664193
Name:MAHALINGAM, PUSHPA (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
Middle Name:
Last Name:MAHALINGAM
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 1:3805 E BELL RD
Mailing Address - Street 2:STE. 2100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2105
Mailing Address - Country:US
Mailing Address - Phone:602-404-5200
Mailing Address - Fax:602-404-5228
Practice Address - Street 1:3805 E BELL RD
Practice Address - Street 2:STE. 2100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2105
Practice Address - Country:US
Practice Address - Phone:602-404-5200
Practice Address - Fax:602-404-5228
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14576208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172320Medicaid
AZWCKJN06Medicare ID - Type Unspecified
AZ172320Medicaid