MEDICARE: MRS. GOMATHY MOHAN MD

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	208000000X	Pediatrics Physician	ME90824	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528016813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GOMATHY MOHAN MD

Provider Business Mailing Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	STE 118
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-429-5898
Fax Number	:	561-429-5897

Provider Business Practice Location Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	STE 118
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-429-5898
Fax Number	:	561-429-5897

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/21/2011

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