Individual
MR. MOHAN D POTLURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1662 CENTRAL AVE, ALBANY, NY 12205-4001
(518) 869-9692
(518) 869-7220
Mailing address
1662 CENTRAL AVE, ALBANY, NY 12205-4001
(518) 869-9692
(518) 869-7220
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
134947
NY
208D00000X
General Practice Physician
Primary
134947
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000400079001
URGENT CARE
—
01
—
000401122000
BLUE SHIELD OF NENY
—
01
—
000401122001
BLUE SHIELD OF NENY
—
01
—
000461122003
BLUE SHIELD OF NENY
—
01
—
0061396
GHI
—
01
—
01137
MVP
—
01
—
01138
MVP
—
01
—
01146
MVP
—
01
—
04B091
BLUE CROSS BLUE SHIELD
—
01
—
10001639
CDPHP
—
01
—
4544624
AETNA
—
01
—
52E592
BLUE CROSS BLUE SHIELD
—
01
—
53242
GHI HMO
—
01
—
5500530
GHI
—
01
—
55582
GHI HMO
—
01
—
9521451
GHI
—
Enumeration date
12/27/2005
Last updated
05/05/2011
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