Provider Demographics
NPI:1114406469
Name:RAJA MOHAN MD PA
Entity Type:Organization
Organization Name:RAJA MOHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-917-5721
Mailing Address - Street 1:7777 FOREST LN STE C820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2552
Mailing Address - Country:US
Mailing Address - Phone:469-301-1725
Mailing Address - Fax:469-301-1769
Practice Address - Street 1:7777 FOREST LN STE C820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2552
Practice Address - Country:US
Practice Address - Phone:469-301-1725
Practice Address - Fax:469-301-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty