Provider Demographics
NPI:1356334353
Name:DADHANIA, MAHENDRA P (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:P
Last Name:DADHANIA
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 1:801 ROUTE 73 NORTH, STE B
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-596-3100
Mailing Address - Fax:856-596-3133
Practice Address - Street 1:801 ROUTE 73 NORTH, STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-596-3100
Practice Address - Fax:856-596-3133
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA6033900207K00000X
NJ25MA06033900207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6423906Medicaid
NJF55706Medicare UPIN
NJ6423906Medicaid