Provider Demographics
NPI:1952340887
Name:VODAPALLY, MOHAN (MD,DABPM)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:VODAPALLY
Suffix:
Gender:M
Credentials:MD,DABPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 WHITNEY AVE, SUITE1
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3211
Mailing Address - Country:US
Mailing Address - Phone:203-624-4400
Mailing Address - Fax:203-624-4402
Practice Address - Street 1:2447 WHITNEY AVE, SUITE 1
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3211
Practice Address - Country:US
Practice Address - Phone:203-624-4400
Practice Address - Fax:203-624-4402
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039595207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7070292OtherAETNA
CTA752119OtherOXFORD
CT039595OtherCONNECTICARE
CT223514271OtherUNITED HEALTHCARE
CT5061151001OtherCIGNA
CT223514271OtherHMC/PPO
CT00139595500OtherBLUECARE FAMILY PLAN
CT010039595CT01OtherBLUE CROSS BLUE SHIELD
CT00139595500OtherBLUECARE FAMILY PLAN
CTH40494Medicare UPIN
CT223514271OtherHMC/PPO