Healthcare Provider Details

I. General information

NPI: 1821062860
Provider Name (Legal Business Name): BRIJ MOHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 EASTON NAZARETH HWY SUITE 104
EASTON PA
18045-8344
US

IV. Provider business mailing address

1249 FIRETHORN DR.
EASTON PA
18045
US

V. Phone/Fax

Practice location:
  • Phone: 610-559-0300
  • Fax: 610-559-1324
Mailing address:
  • Phone: 610-730-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD026847E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD026847E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD026847E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD026847E
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25501
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD026847E
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD026847E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: