Individual
DR. MOHAN NUTHAKKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 GLEN COVE DR, ROCKPORT, ME 04856-4272
(207) 301-8000
Mailing address
6680 POE AVE, SUITE 200, DAYTON, OH 45414-2854
(937) 280-8400
(937) 280-8373
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
060174
OH
207RH0003X
Hematology & Oncology Physician
MD24746
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000756487
ANTHEM
OH
05
—
0167555
—
OH
05
—
0795797
—
OH
Enumeration date
08/14/2007
Last updated
06/11/2021
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