Provider Demographics
NPI:1649379652
Name:DHILLON, MOHAN DS (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:DS
Last Name:DHILLON
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 1:4182 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTEN
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-724-2346
Mailing Address - Fax:
Practice Address - Street 1:4104 OLD VESTAL RD
Practice Address - Street 2:SUITE #108
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3554
Practice Address - Country:US
Practice Address - Phone:607-729-0726
Practice Address - Fax:607-729-1341
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1861771207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01274928Medicaid
E95236Medicare UPIN
NY52825CMedicare PIN