Basic Information
| Provider Information | |||||||||
| NPI: | 1568686806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAMBALAM | ||||||||
| FirstName: | MOHAN | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 14TH ST NW | ||||||||
| Address2: | SUITE 402B | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200096865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027454300 | ||||||||
| FaxNumber: | 2022320723 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 D ST SE | ||||||||
| Address2: | MEDICAL UNIT | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200032534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026738251 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | MD20945 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.