Provider Demographics
NPI:1821219841
Name:MOHAN, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name: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 1:25700 SCIENCE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7328
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:216-450-1614
Practice Address - Street 1:25700 SCIENCE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7328
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:216-450-1614
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0973912084P0800X, 2084S0012X
OH35-0973912084P0800X
MN509162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
OH0058321Medicaid
OHH052541Medicare PIN
MN260002903Medicare PIN