Provider Demographics
NPI:1780959965
Name:MAHAJAN, SMITA MILIND (MD)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:MILIND
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SMITA
Other - Middle Name:MADHUKAR
Other - Last Name:NILANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:605 PROSPECT ST
Mailing Address - Street 2:APT C
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2109
Mailing Address - Country:US
Mailing Address - Phone:203-773-1828
Mailing Address - Fax:
Practice Address - Street 1:605 PROSPECT ST
Practice Address - Street 2:APT C
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2109
Practice Address - Country:US
Practice Address - Phone:203-773-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program