Provider Demographics
NPI:1295732998
Name:MOHAN, VEDAGIRI K (MD)
Entity type:Individual
Prefix:
First Name:VEDAGIRI
Middle Name:K
Last Name:MOHAN
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 1:2142 NORTH COVE BLVD, 3RD FLOOR
Mailing Address - Street 2:PO BOX 12498
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-0098
Mailing Address - Country:US
Mailing Address - Phone:419-291-4225
Mailing Address - Fax:419-479-6193
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-4225
Practice Address - Fax:419-479-6193
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH529672080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000129746OtherANTHEM
MI1295732998Medicaid
4002514OtherAETNA
OH4700066OtherUNITED HEALTHCARE
OH0619816Medicaid
OH10256OtherPARAMOUNT