Individual
DR. MOHAN GURUBHAGAVATULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
225 E CITY AVE STE 215, BALA CYNWYD, PA 19004-1704
(610) 664-8200
(866) 267-4029
Mailing address
225 E CITY AVE STE 215, BALA CYNWYD, PA 19004-1704
(610) 664-8200
(866) 267-4029
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
OS012602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GU1507200
PIN NUMBER
PA
Enumeration date
01/27/2006
Last updated
07/29/2025
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