MEDICARE: THOMAS J MOHAN JR. P.A.

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	363A00000X	Physician Assistant	PA.0007240	CO
2	363A00000X	Physician Assistant	0010-11259	NC
3	363A00000X	Physician Assistant	PA16602	CA

General Provider Information

NPI Number	:	1861508590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J MOHAN JR. P.A.

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 MOUNT WOODMEN CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1029
Country	:	US
Telephone Number	:	949-929-5440
Fax Number	:	719-365-7680

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/27/2023

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