Basic Information
| Provider Information | |||||||||
| NPI: | 1952734469 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAHAJAN THERAPEUTICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2954 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407762785 | ||||||||
| FaxNumber: | 7407762793 | ||||||||
| Practice Location | |||||||||
| Address1: | 2954 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407762785 | ||||||||
| FaxNumber: | 7407762793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 08/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | EASTERLING | ||||||||
| AuthorizedOfficialFirstName: | IVA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7407762785 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.