Provider Demographics
NPI:1912932237
Name:MOONDRA, MAHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:
Last Name:MOONDRA
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 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 504B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-546-5954
Mailing Address - Fax:410-219-3038
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 504B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:410-546-5954
Practice Address - Fax:410-219-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0032014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD394811100Medicaid
MDB67286Medicare UPIN
MD394811100Medicaid