Provider Demographics
NPI:1861499469
Name:NARAYANAN, MOHAN (MD, PA)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:NARAYANAN
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34265-0548
Mailing Address - Country:US
Mailing Address - Phone:863-494-5909
Mailing Address - Fax:863-494-0539
Practice Address - Street 1:810 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8780
Practice Address - Country:US
Practice Address - Phone:863-494-5909
Practice Address - Fax:863-494-0539
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2010-09-10
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLME27048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057934300Medicaid
FL78901OtherBLUE CROSS BLUE SHIELD
FL407111115OtherRAILROAD MEDICARE
FL78901Medicare ID - Type Unspecified
FL407111115OtherRAILROAD MEDICARE