Provider Demographics
NPI:1811178411
Name:MOHAN, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
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:CLEVELAND CLINIC MAIN CAMPUS
Mailing Address - Street 2:9500 EUCLID AVENUE, DESK G10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-9703
Mailing Address - Fax:216-445-1007
Practice Address - Street 1:CLEVELAND CLINIC MAIN CAMPUS
Practice Address - Street 2:9500 EUCLID AVENUE, DESK G10
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-9703
Practice Address - Fax:216-445-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201427207R00000X
OH35.099176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1215686Medicaid
LA1215686Medicaid