Provider Demographics
NPI:1477588259
Name:MOHAN, CHITTUR R (MD)
Entity Type:Individual
Prefix:
First Name:CHITTUR
Middle Name:R
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2589
Mailing Address - Country:US
Mailing Address - Phone:215-497-0637
Mailing Address - Fax:
Practice Address - Street 1:2000 GRANT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4378
Practice Address - Country:US
Practice Address - Phone:215-969-3944
Practice Address - Fax:215-969-3886
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046075L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0127841000OtherKHPE
PA001728040000Medicaid
PA021789JLROtherMEDICARE
PA0000892580OtherBLUE SHIELD
PA2494280OtherAETNA