Basic Information
| Provider Information | |||||||||
| NPI: | 1255310983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHALINGAM | ||||||||
| FirstName: | SUDHA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | LOCATION 0883 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452640001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778415125 | ||||||||
| FaxNumber: | 8593634984 | ||||||||
| Practice Location | |||||||||
| Address1: | 10506 MONTGOMERY RD | ||||||||
| Address2: | SUITE G102 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593634886 | ||||||||
| FaxNumber: | 8593634984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35044562M | OH | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0481750 | 05 | OH | MEDICAID |