| Doctor Name: | DR. CHANDLER VIMAL MOHAN |
| NPI Number: | 1629239561 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101243179 |
| Business Practice Address: | 351 Ne Franklin St Suite 1125 Lake City, FL - 320553089 |
| Business Phone Number: | 3864661106 |
| Business Fax Number: | 3864661821 |
| Mailing Address: | 351 Ne Franklin St, Suite 1125 LAKE CITY |
| State: | FL |
| Postal Code: | 320553089 |
| Phone Number: | 3864661106 |
| Fax Number: | 3864661821 |
| NPI Enumeration Date: | 06/23/2008 |
| NPI Last Update Date: | 10/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101243179 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |