Provider Demographics
NPI:1194770594
Name:PILLAI, MOHAN V (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:V
Last Name:PILLAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 FIRST BAXTER CROSSING
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8954
Mailing Address - Country:US
Mailing Address - Phone:803-802-2488
Mailing Address - Fax:803-802-3352
Practice Address - Street 1:1700 FIRST BAXTER CROSSING
Practice Address - Street 2:SUITE 202
Practice Address - City:FOR MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8954
Practice Address - Country:US
Practice Address - Phone:803-802-2488
Practice Address - Fax:803-802-3352
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05988Medicare UPIN
SCH05988Medicare UPIN