1730146499 NPI number — DR. ROBERT L MAHANTI M.D.

Table of content: DR. ROBERT L MAHANTI M.D. (NPI 1730146499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730146499 NPI number — DR. ROBERT L MAHANTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHANTI
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730146499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31012
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86003-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-779-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 N SAN FRANCISCO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-3236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-779-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  20847 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0380480 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1659445062 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180022943 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110510 . This is a "APIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG6643 . This is a "MEDICARE RAILROAD GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110510 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290066 . This is a "MEDICAID GROUP" identifier . This identifiers is of the category "OTHER".




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