Provider Demographics
NPI:1942201710
Name:MOHAN, VEENA (MD)
Entity type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172327
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-2327
Mailing Address - Country:US
Mailing Address - Phone:901-767-1100
Mailing Address - Fax:901-761-9703
Practice Address - Street 1:4066 SUMMER AVE STE. 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122
Practice Address - Country:US
Practice Address - Phone:901-767-1100
Practice Address - Fax:901-682-3192
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3895430Medicaid
3895430Medicare PIN
TN3895430Medicaid