Individual
DR. MAMATHA G. MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
60 EVERGREEN PLACE, SUITE 400, EAST ORANGE, NJ 07018
(973) 395-1550
(973) 395-1556
Mailing address
21 EDGEWOOD ROAD, SUMMIT, NJ 07901
(970) 395-1550
(973) 395-1556
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA08172600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200019307
BLUE CROSS BLUE SHIELD
NJ
01
—
P00059104
RAILROAD MEDICARE
NJ
Enumeration date
03/05/2007
Last updated
07/27/2020
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