Provider Demographics
NPI:1558300533
Name:CHANDRAN, MOHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:S
Last Name:CHANDRAN
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 1:1200 PROSPECT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3362
Mailing Address - Country:US
Mailing Address - Phone:419-621-9026
Mailing Address - Fax:419-624-1260
Practice Address - Street 1:1200 PROSPECT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3362
Practice Address - Country:US
Practice Address - Phone:419-621-9026
Practice Address - Fax:419-624-1260
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0644422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0758192Medicare ID - Type Unspecified
OHF79297Medicare UPIN