MEDICARE: DR. SAMUEL A MOHRAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518192111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL A MOHRAN M.D.

Provider Business Mailing Address
First Line	:	4764 NORSTAR BLVD
Second Line	:	APT. 218
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-4254
Country	:	US
Telephone Number	:	315-456-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2342
Country	:	US
Telephone Number	:	315-464-5136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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