Healthcare Provider Details

I. General information

NPI: 1801846043
Provider Name (Legal Business Name): MOHAN R RENGEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

IV. Provider business mailing address

899 POPLAR CHURCH RD
CAMP HILL PA
17011-2206
US

V. Phone/Fax

Practice location:
  • Phone: 717-763-0430
  • Fax: 717-763-9854
Mailing address:
  • Phone: 717-763-0430
  • Fax: 717-763-9854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS013674
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: