Provider Demographics
NPI:1215968821
Name:N CHANDRAMOHAN MD PA
Entity type:Organization
Organization Name:N CHANDRAMOHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANJAPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-315-1550
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:EUTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32727-1316
Mailing Address - Country:US
Mailing Address - Phone:352-315-1550
Mailing Address - Fax:352-315-1557
Practice Address - Street 1:32845 RADIO ROAD
Practice Address - Street 2:STE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788
Practice Address - Country:US
Practice Address - Phone:352-315-1550
Practice Address - Fax:352-315-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84234207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7954Medicare ID - Type Unspecified
B16563Medicare UPIN