Provider Demographics
NPI:1568477248
Name:SUNTHA, MOHAN (MD/MBA)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:SUNTHA
Suffix:
Gender:M
Credentials:MD/MBA
Other - Prefix:
Other - First Name:MOHAN
Other - Middle Name:
Other - Last Name:SUNTHARALINGAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD/MBA
Mailing Address - Street 1:PO BOX 64620
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4620
Mailing Address - Country:US
Mailing Address - Phone:410-328-3037
Mailing Address - Fax:410-328-3040
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:GUDELSKY BASEMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3037
Practice Address - Fax:410-328-3040
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD476182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD443861200Medicaid
MD443861200Medicaid
DC920006347Medicare PIN
MD722MMedicare PIN
MDG08082Medicare UPIN
DC00A217U99Medicare PIN