Provider Demographics
NPI:1437152246
Name:GOVINDAN, MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:GOVINDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-452-7000
Mailing Address - Fax:978-458-2828
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-7000
Practice Address - Fax:978-458-2828
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226311207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81260Medicare UPIN