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MOHIT SOURABH KASIBHATLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
50 MAUDE ST, PROVIDENCE, RI 02908-4325
(401) 456-2690
(401) 456-6540
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DET., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
2006-01262
NC
2085R0001X
Radiation Oncology Physician
Primary
MD12575
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008032332
CT
01
7263727
AETNA
RI
05
MK69589
RI
01
P00756245
RAILROAD MEDICARE - RWRT
RI
01
P00762785
RAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
RI
01
P00912570
RAILROAD MEDICARE - SOUTH COUNTY
RI
01
P01044492
RAILROAD MEDICARE - SOUTHERN NEW ENGLAND REGIONAL CANCER
RI
Enumeration date
09/29/2006
Last updated
01/05/2022
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