Provider Demographics
NPI:1467488940
Name:MOHAN, SOWJANYA S (MD)
Entity Type:Individual
Prefix:
First Name:SOWJANYA
Middle Name:S
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 1:424 CAVAYO TRL
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4392
Mailing Address - Country:US
Mailing Address - Phone:210-957-2620
Mailing Address - Fax:
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-297-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3902207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG58079Medicaid
SCG58079Medicaid
GA44ZCBMGMedicare PIN
SCAA17417635Medicare PIN