Basic Information
| Provider Information | |||||||||
| NPI: | 1295471100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAJAN | ||||||||
| FirstName: | ELISH | ||||||||
| MiddleName: | DEV | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 FOSTER ST UNIT 421 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277012276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192710002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507256500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2022 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | 0000000 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
No ID Information.