Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12011030A | IN |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8191 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8181 | KY |
NPI | 1154310985 |
---|---|
Provider Name | Dr. Maneesh Mohan |
First Address | New Albany, IN 47150-4962 |
Second Address | Louisville, KY 40219-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200872180 | (05) | IN |
204E0000X | (05) | KY |
50007575 | PASSPORT (01) | KY |
6411381400 | (05) | KY |
9179239 | DORAL (01) | KY |