Basic Information
| Provider Information | |||||||||
| NPI: | 1316944960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMADANA | ||||||||
| FirstName: | MOHAN | ||||||||
| MiddleName: | RAO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 S TRIMBLE RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449063437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197740478 | ||||||||
| FaxNumber: | 4197749887 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 S TRIMBLE RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449063437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197740478 | ||||||||
| FaxNumber: | 4197749887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 35042134 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | KI9260531 | 01 | OH | GROUP MEDICARE | OTHER | 0114549 | 01 | OH | GROUP MEDICAID | OTHER | 0428497 | 05 | OH | MEDICAID |