Provider Demographics
NPI:1942002613
Name:MAHESH BOTEJUE MD LLC
Entity type:Organization
Organization Name:MAHESH BOTEJUE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTEJUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-255-4162
Mailing Address - Street 1:237 S FRASER ST STE 442
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 W 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1333
Practice Address - Country:US
Practice Address - Phone:858-255-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty