Provider Demographics
NPI:1861508590
Name:MOHAN, THOMAS J JR (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MOHAN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2420
Mailing Address - Fax:
Practice Address - Street 1:1530 MOUNT WOODMEN CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1029
Practice Address - Country:US
Practice Address - Phone:949-929-5440
Practice Address - Fax:719-365-7680
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007240363A00000X
NC0010-11259363A00000X
CAPA16602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP69377Medicare UPIN
CA0PA166021Medicare PIN