Individual
CHITTUR R MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 GRANT AVE, SUITE 201, PHILADELPHIA, PA 19115-4378
(215) 969-3944
(215) 969-3886
Mailing address
2 PADDOCK WAY, HOLLAND, PA 18966-2589
(215) 497-0637
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD046075L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000892580
BLUE SHIELD
PA
05
—
001728040000
—
PA
01
—
0127841000
KHPE
PA
01
—
021789JLR
MEDICARE
PA
01
—
2494280
AETNA
PA
Enumeration date
07/11/2006
Last updated
09/29/2021
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