Provider Demographics
NPI:1982893582
Name:LALITH MOHAN, ADAMANE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAMANE
Middle Name:S
Last Name:LALITH MOHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:108 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2357
Mailing Address - Country:US
Mailing Address - Phone:707-762-5078
Mailing Address - Fax:707-763-7030
Practice Address - Street 1:108 LYNCH CREEK WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2357
Practice Address - Country:US
Practice Address - Phone:707-762-5078
Practice Address - Fax:707-763-7030
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2021-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA32849207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A328490Medicare PIN
CAC03913Medicare UPIN