Provider Demographics
NPI:1619232139
Name:PAPPU MOHAN, BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:BABU
Middle Name:
Last Name:PAPPU 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 1:1507 S HIAWASSEE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-445-9224
Mailing Address - Fax:
Practice Address - Street 1:1507 S HIAWASSEE RD STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-445-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157973207RG0100X, 207RG0100X
ALMD35030208M00000X
OH35.125513208M00000X
UT11565770-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist