Provider Demographics
NPI:1992771521
Name:MOHAN, RAVINDER (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:
Last Name:MOHAN
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 1:5320 PROVIDENCE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4122
Mailing Address - Country:US
Mailing Address - Phone:757-413-7600
Mailing Address - Fax:757-507-9051
Practice Address - Street 1:5320 PROVIDENCE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-413-7600
Practice Address - Fax:757-507-9051
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005604133Medicaid
VA1992771521OtherAETNA
VA1992771521OtherUNITED HEALTHCARE
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL/CORCARE
VA-002 -003OtherTRICARE/CHAMPUS
VA1992771521OtherANTHEM BC/BS
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VA1992771521OtherOPTIMA HEALTH
VA005638411Medicaid
VA1992771521OtherVIRGINIA PREMIER HEALTH PLAN
NC790571YMedicaid
VA1992771521OtherAETNA
VA1992771521OtherOPTIMA HEALTH
VA1992771521OtherANTHEM BC/BS
VA005604133Medicaid
VA080138469Medicare PIN