MEDICARE: MOHAN PHANSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD035012L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750343026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAN PHANSE MD

Provider Business Mailing Address
First Line	:	80 LANDINGS DRIVE
Second Line	:	SUITE 205
City	:	WASHINGTON
State	:	PA
Zip	:	15301-9408
Country	:	US
Telephone Number	:	724-941-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 LANDINGS DRIVE
Second Line	:	SUITE 205
City	:	WASHINGTON
State	:	PA
Zip	:	15301-9408
Country	:	US
Telephone Number	:	724-941-3020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	02/09/2015

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Directions to “ MOHAN PHANSE MD” Practice Location

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