Active NPI
Suneel L Mahajan, MD
- Hematology & Oncology Physician
- Jacksonville, FL
National Provider Identifier
1528063856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- ME 42191
- Practice address
- 5742 Booth Rd
Suite a
Jacksonville, FL 32207-5982 - Phone
- (904) 739-7779
- Fax
- (904) 739-7771
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | ME 42191 | FL | Primary |
Addresses
Primary practice location
5742 Booth Rd
Suite a
Jacksonville, FL 32207-5982
Mailing address
7015 Ac Skinner Parkway
Suite 1
Jacksonville, FL 32256
Phone (904) 363-2113
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 914407571A | Medicaid | GA | |
| 4047692 | Other | FL | AETNA |
| 15785 | Other | FL | BCBS |
| 203539 | Other | FL | AVMED |
| 067558000 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 42191 | FL | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370563200000",
"number": "1528063856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7015 AC SKINNER PARKWAY",
"address_2": "SUITE 1",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32256",
"telephone_number": "904-363-2113",
"fax_number": "904-363-2606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5742 BOOTH RD",
"address_2": "SUITE A",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322075982",
"telephone_number": "904-739-7779",
"fax_number": "904-739-7771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHAJAN",
"first_name": "SUNEEL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2013-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "FL",
"license": "ME 42191",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "914407571A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4047692",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "15785",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVMED",
"identifier": "203539",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "067558000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.