Provider Demographics
NPI:1720068968
Name:AMLANI, MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:AMLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHANKUMAR
Other - Middle Name:
Other - Last Name:AMLANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11336 WILLOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2467
Mailing Address - Country:US
Mailing Address - Phone:443-794-8929
Mailing Address - Fax:443-296-9510
Practice Address - Street 1:11336 WILLOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2467
Practice Address - Country:US
Practice Address - Phone:410-730-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
540SMedicare PIN