Provider Demographics
NPI:1861540544
Name:NARENDRA K MAHESHWARI MD PA
Entity type:Organization
Organization Name:NARENDRA K MAHESHWARI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHESHWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-942-9233
Mailing Address - Street 1:601 E SAMPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4443
Mailing Address - Country:US
Mailing Address - Phone:954-942-9233
Mailing Address - Fax:954-942-9234
Practice Address - Street 1:601 E SAMPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4443
Practice Address - Country:US
Practice Address - Phone:954-942-9233
Practice Address - Fax:954-942-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060039207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371360100Medicaid
FLF31563Medicare UPIN
FL15088Medicare ID - Type Unspecified