Provider Demographics
NPI:1114921806
Name:MOHAN, GOWDHAMI (MD)
Entity Type:Individual
Prefix:
First Name:GOWDHAMI
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 E GREENVILLE ST STE D
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2285
Mailing Address - Country:US
Mailing Address - Phone:864-222-3000
Mailing Address - Fax:864-437-8799
Practice Address - Street 1:1403 E GREENVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2049
Practice Address - Country:US
Practice Address - Phone:864-222-3000
Practice Address - Fax:864-437-8799
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17935207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT20901Medicaid
SCP00944908OtherRR MEDICARE
GA050001919CMedicaid
SC8607OtherMEDICARE GROUP NUMBER
SCP00944908OtherRR MEDICARE
GA050001919CMedicaid
SC7111Medicare PIN