Physician Compare National (NPI:1467423624)

HEALTHCARE PROVIDER: MOHAN GURUBHAGAVATULA DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1467423624
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638238470
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081107000288
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GURUBHAGAVATULA
	Individual professional last name
Provider First Name	MOHAN
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KANSAS CITY COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	RHEUMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2 BALA PLZ
	Group Practice or individual's line 1 address
City	BALA CYNWYD
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	190041501
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHESTNUT HILL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390304
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ROXBOROUGH MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y