Healthcare Provider Details

I. General information

NPI: 1033115092
Provider Name (Legal Business Name): SHANTHI MOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 WILSON AVE
HANOVER PA
17331-7902
US

IV. Provider business mailing address

671 WILSON AVE
HANOVER PA
17331-7902
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-1559
  • Fax: 717-632-5557
Mailing address:
  • Phone: 717-632-1559
  • Fax: 717-632-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD418310
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: