Provider Demographics
NPI:1134216351
Name:DHIRENDRA MOHAN MDPC
Entity type:Organization
Organization Name:DHIRENDRA MOHAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHIRENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-539-9859
Mailing Address - Street 1:10 HOSPITAL DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6603
Mailing Address - Country:US
Mailing Address - Phone:413-539-9859
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:SUITE 302
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-539-9859
Practice Address - Fax:000-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH 10153OtherBLUE SHIELD
MA9724117Medicaid
MOH 10153OtherBLUE SHIELD