Provider Demographics
NPI:1245328152
Name:CHOHAN, MR (MD)
Entity type:Individual
Prefix:DR
First Name:MR
Middle Name:
Last Name:CHOHAN
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 1:4685 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3242
Mailing Address - Country:US
Mailing Address - Phone:440-967-3149
Mailing Address - Fax:440-967-3140
Practice Address - Street 1:4685 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3242
Practice Address - Country:US
Practice Address - Phone:440-967-3149
Practice Address - Fax:440-967-3140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039174207R00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0327622Medicaid
OHD-31220Medicare UPIN
OH0327622Medicaid