Provider Demographics
NPI:1982685533
Name:MAHENDRAN, RATHIPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:RATHIPRIYA
Middle Name:
Last Name:MAHENDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NORTH WABASH AVE
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7600
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:831 THEATRE DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-4470
Practice Address - Country:US
Practice Address - Phone:765-660-7800
Practice Address - Fax:765-662-4470
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01054397A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000214428OtherANTHEM BCBS
IN200371420Medicaid
IN200371420Medicaid
000000214428OtherANTHEM
H56513Medicare UPIN