Provider Demographics
NPI:1518976729
Name:DEOCHAND, MOHAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:C
Last Name:DEOCHAND
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:PO BOX 3294
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-3294
Mailing Address - Country:US
Mailing Address - Phone:919-774-4536
Mailing Address - Fax:919-774-4578
Practice Address - Street 1:114 S. GULF ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-774-4536
Practice Address - Fax:919-774-4578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1059252084N0400X
NC99008142084N0600X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128C6OtherBCBS
NC89128C6Medicaid
NC9900814OtherSTATE LIC NUBMER
NC128C6OtherBCBS
NC562221844OtherFED TAX NUMBER
NC128C6OtherBCBS
NC7278117OtherDEA NUMBER
NC562221844OtherFED TAX NUMBER