Healthcare Provider Details

I. General information

NPI: 1295738433
Provider Name (Legal Business Name): CHANDRA MOHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARUTHAIYAN CHANDRAMOHAN MD

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S GEORGE ST STE W-2
YORK PA
17403-4594
US

IV. Provider business mailing address

2200 S GEORGE ST STE W-2
YORK PA
17403-4594
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-2222
  • Fax: 717-741-2266
Mailing address:
  • Phone: 717-741-2222
  • Fax: 717-741-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD418311
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD418311
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: