Provider Demographics
NPI:1134258486
Name:MOHAN, AVINASH LALITH (MD)
Entity type:Individual
Prefix:DR
First Name:AVINASH
Middle Name:LALITH
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4 WESTCHESTER PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3497
Mailing Address - Country:US
Mailing Address - Phone:914-948-8003
Mailing Address - Fax:914-686-5478
Practice Address - Street 1:4 WESTCHESTER PARK DR FL 4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3434
Practice Address - Country:US
Practice Address - Phone:914-948-8448
Practice Address - Fax:914-345-8122
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY249950207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118755Medicaid
NYA400005521Medicare PIN
IL036118755Medicaid