Provider Demographics
NPI:1336443621
Name:PRABHA MOHAN MD PA
Entity Type:Organization
Organization Name:PRABHA MOHAN MD PA
Other - Org Name:PRABHA MOHAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSEE
Authorized Official - Phone:469-569-7140
Mailing Address - Street 1:709 ED HALL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1860
Mailing Address - Country:US
Mailing Address - Phone:972-932-2000
Mailing Address - Fax:972-932-0316
Practice Address - Street 1:709 ED HALL DR
Practice Address - Street 2:SUITE C
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1860
Practice Address - Country:US
Practice Address - Phone:972-932-2000
Practice Address - Fax:972-932-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-01
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1567261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029765701Medicaid
TX029765701Medicaid
TXF79107Medicare UPIN