Individual ProviderDivyasudha MohanFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address10800 Knights Rd, Philadelphia, PA 19114-4200(215) 612-5161PECOS EnrollmentBased on the most recent information from CMS, provider Divyasudha Mohan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:30 AM.Profile DetailsProvider ID1336597780Provider TypeIndividualFull NameMohan, DivyasudhaTitleDr.CredentialD.O.GenderFemaleSole ProprietorNoEnumeration Date5/26/2016Last Updated2/7/2024Contact InformationPractice LocationPractice Address10800 Knights Rd, Philadelphia, PA 19114-4200Phone(215) 612-5161FaxUnlisted FaxMailing LocationMailing Address10800 Knights Rd, Philadelphia, PA 19114-4200Phone(215) 612-5161FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseOS019595PennsylvaniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseOT017058PennsylvaniaCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicenseOS019595Pennsylvania