Provider Demographics
NPI:1063783116
Name:PREVILUS, MAHALIA RUTH (MD)
Entity type:Individual
Prefix:
First Name:MAHALIA
Middle Name:RUTH
Last Name:PREVILUS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7207
Mailing Address - Country:US
Mailing Address - Phone:929-641-1151
Mailing Address - Fax:646-439-8147
Practice Address - Street 1:127 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7207
Practice Address - Country:US
Practice Address - Phone:929-641-1151
Practice Address - Fax:646-439-8147
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201301805207R00000X
WV25126207R00000X
NY265950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine