Basic Information
| Provider Information | |||||||||
| NPI: | 1053310227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHANT | ||||||||
| FirstName: | PADMA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAJASEKHARA | ||||||||
| OtherFirstName: | PADMA | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4530 E MUIRWOOD DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809612365 | ||||||||
| FaxNumber: | 4809612382 | ||||||||
| Practice Location | |||||||||
| Address1: | 4530 E MUIRWOOD DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809612365 | ||||||||
| FaxNumber: | 4809612382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 08/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 27844 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.