| Mahajan Therapeutics, Llc | |
|
6300 N Main St Dayton OH 45415-3154 | |
| (937) 275-1500 | |
| (937) 275-1555 |
| Full Name | Mahajan Therapeutics, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6300 N Main St, Dayton, Ohio |
| Authorized Official Name and Position | Bruce Jarvie (VP, TREASURER) |
| Authorized Official Contact | 2143793300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahajan Therapeutics, Llc 6300 N Main St Dayton OH 45415-3154 Ph: (937) 275-1500 | Mahajan Therapeutics, Llc 6300 N Main St Dayton OH 45415-3154 Ph: (937) 275-1500 |
| NPI Number | 1669531810 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 8820236524 |
|---|---|
| Medicare Enrollment ID | O20160809001647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669531810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 586 (Ohio) | Primary |
| Provider Name | Rhonda F Smith-bass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700907565 PECOS PAC ID: 5496740292 Enrollment ID: I20040422000010 |
| Provider Name | Lidia M Berrone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467451930 PECOS PAC ID: 1557352143 Enrollment ID: I20040521000728 |
| Provider Name | Jeffrey M Bishop |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811974751 PECOS PAC ID: 5799758538 Enrollment ID: I20040818001172 |
| Provider Name | Yvonne Y Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710963657 PECOS PAC ID: 8325000862 Enrollment ID: I20041027001321 |
| Provider Name | Pravesh B Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164409090 PECOS PAC ID: 1355327875 Enrollment ID: I20050302000541 |
| Provider Name | Melanie M Perkins-fairbanks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538206545 PECOS PAC ID: 8123127701 Enrollment ID: I20070622000027 |
| Provider Name | Aditi M Sheth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154597839 PECOS PAC ID: 2860655339 Enrollment ID: I20120521000046 |
| Provider Name | Rachel A Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306192968 PECOS PAC ID: 1254581739 Enrollment ID: I20121017000951 |
| Provider Name | Erica D Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225377500 PECOS PAC ID: 4082853783 Enrollment ID: I20130610000179 |
| Provider Name | Sheila N Tano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306143722 PECOS PAC ID: 1658500053 Enrollment ID: I20140205001260 |
| Provider Name | Monica Mahajan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053587550 PECOS PAC ID: 7113205816 Enrollment ID: I20161101000885 |
| Provider Name | Chad L Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366805178 PECOS PAC ID: 7315226628 Enrollment ID: I20161109000902 |
| Provider Name | Keith Frazier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588027593 PECOS PAC ID: 5890075196 Enrollment ID: I20161202000535 |
| Provider Name | Melodee Bly Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912350513 PECOS PAC ID: 2365728177 Enrollment ID: I20170414000325 |
| Provider Name | Lesley Jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316479967 PECOS PAC ID: 5092077305 Enrollment ID: I20180327001184 |
| Provider Name | Leticia Rochelle Patterson-hicks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477813681 PECOS PAC ID: 5496017584 Enrollment ID: I20180330000531 |
| Provider Name | Chari L Baire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295263952 PECOS PAC ID: 3577826288 Enrollment ID: I20180411000916 |
| Provider Name | Sandeep M Sheth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720282601 PECOS PAC ID: 7214277938 Enrollment ID: I20190315001833 |
| Provider Name | Destry East |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356796502 PECOS PAC ID: 9638458979 Enrollment ID: I20190724000155 |
| Provider Name | Jason M Lee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619354339 PECOS PAC ID: 5496069288 Enrollment ID: I20190925002509 |
| Provider Name | Hannah Marie Havenar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063079523 PECOS PAC ID: 5698105559 Enrollment ID: I20200417001006 |
| Provider Name | Jennifer Michele Suffridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477184638 PECOS PAC ID: 0143649558 Enrollment ID: I20201005002214 |
| Provider Name | Christina K Vaughn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417531799 PECOS PAC ID: 1254733637 Enrollment ID: I20220630002166 |
| Provider Name | John Sullenbarger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356845176 PECOS PAC ID: 8022369461 Enrollment ID: I20220914001872 |
| Provider Name | Jason D Patterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568091536 PECOS PAC ID: 5991126021 Enrollment ID: I20230616001210 |
| Provider Name | Ok S Ji |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760943187 PECOS PAC ID: 4981938768 Enrollment ID: I20230619001440 |
| Provider Name | Andy C Hur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447813720 PECOS PAC ID: 0042545089 Enrollment ID: I20230619001776 |
| Provider Name | Michael S Hatesohl |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427510510 PECOS PAC ID: 8325381189 Enrollment ID: I20230620001180 |
| Provider Name | Stephen B Edstrom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396942264 PECOS PAC ID: 4082909684 Enrollment ID: I20230727003418 |
| Provider Name | Alyssa Arena |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417510793 PECOS PAC ID: 4082948104 Enrollment ID: I20230807002729 |
| Provider Name | Christine Boysel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659936540 PECOS PAC ID: 4284082785 Enrollment ID: I20231121003938 |
| Provider Name | Susan Marie Havens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821214677 PECOS PAC ID: 1951486034 Enrollment ID: I20240314003928 |
| Provider Name | Justin M Tom |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093390148 PECOS PAC ID: 0941609580 Enrollment ID: I20240321002532 |
| Provider Name | Evan Ely |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306398854 PECOS PAC ID: 7618314501 Enrollment ID: I20240327003277 |
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