Healthcare Provider Details

I. General information

NPI: 1689759532
Provider Name (Legal Business Name): SARASWATHI MOHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 CARRIAGE DR
BECKLEY WV
25801-2804
US

IV. Provider business mailing address

34 AVOCET WAY
BECKLEY WV
25801-1601
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-6051
  • Fax: 304-255-6051
Mailing address:
  • Phone: 304-252-0575
  • Fax: 304-252-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18401
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: