Provider Demographics
NPI:1619551355
Name:MOHAN, ASHWATHI SARAYU (MD PHD)
Entity Type:Individual
Prefix:
First Name:ASHWATHI
Middle Name:SARAYU
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 W PINE BLVD APT 519
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1989
Mailing Address - Country:US
Mailing Address - Phone:210-417-7329
Mailing Address - Fax:
Practice Address - Street 1:601 N CAROLINE ST # 8152C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-502-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program