Healthcare Provider Details

I. General information

NPI: 1699772574
Provider Name (Legal Business Name): NANJAPPA CHANDRAMOHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/18/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 SW 19TH AVENUE RD STE 103
OCALA FL
34471-7877
US

IV. Provider business mailing address

PO BOX 2556
OCALA FL
34478-2556
US

V. Phone/Fax

Practice location:
  • Phone: 352-368-1360
  • Fax: 352-237-7728
Mailing address:
  • Phone: 352-274-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME84234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: