Healthcare Provider Details

I. General information

NPI: 1316927668
Provider Name (Legal Business Name): GEETHA MOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD SUITE 127
LORAIN OH
44053-1654
US

IV. Provider business mailing address

3600 KOLBE RD SUITE 127
LORAIN OH
44053-1654
US

V. Phone/Fax

Practice location:
  • Phone: 440-414-9200
  • Fax: 216-201-5582
Mailing address:
  • Phone: 440-414-9200
  • Fax: 216-201-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35063115
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35063115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: