Provider Demographics
NPI:1891777389
Name:MAHADEVAN, ANAND (MBBS)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:MAHADEVAN
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-731-6033
Mailing Address - Fax:212-731-5513
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822
Practice Address - Country:US
Practice Address - Phone:570-271-6304
Practice Address - Fax:570-271-6940
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4594572085R0001X
NY3136392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032531910002Medicaid
MA2015056Medicaid
MAH90698Medicare UPIN
PA1032531910002Medicaid