Provider Demographics
NPI:1841382660
Name:KASIBHATLA, MOHIT SOURABH (MD)
Entity Type:Individual
Prefix:
First Name:MOHIT
Middle Name:SOURABH
Last Name:KASIBHATLA
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DET.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-2690
Practice Address - Fax:401-456-6540
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-012622085R0001X
RIMD125752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008032332Medicaid
RIP00756245OtherRAILROAD MEDICARE - RWRT
RIP01044492OtherRAILROAD MEDICARE - SOUTHERN NEW ENGLAND REGIONAL CANCER
RIMK69589Medicaid
RI7263727OtherAETNA
RIP00762785OtherRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
RIP00912570OtherRAILROAD MEDICARE - SOUTH COUNTY
RIP00762785OtherRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
RIP01044492OtherRAILROAD MEDICARE - SOUTHERN NEW ENGLAND REGIONAL CANCER
RIP00912570OtherRAILROAD MEDICARE - SOUTH COUNTY
RII38456Medicare UPIN
RIMK69589Medicaid