Basic Information
| Provider Information | |||||||||
| NPI: | 1285786558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHIDHARA | ||||||||
| FirstName: | SESHU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152300049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003437123 | ||||||||
| FaxNumber: | 4129375710 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243577169 | ||||||||
| FaxNumber: | 7243577481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207ZP0102X | 032788 | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 09519300 | 05 | PA | MEDICAID |