Provider Demographics
NPI:1033115092
Name:MOHAN, SHANTHI (MD)
Entity Type:Individual
Prefix:
First Name:SHANTHI
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7902
Mailing Address - Country:US
Mailing Address - Phone:717-632-1559
Mailing Address - Fax:717-632-5557
Practice Address - Street 1:671 WILSON AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7902
Practice Address - Country:US
Practice Address - Phone:717-632-1559
Practice Address - Fax:717-632-5557
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418310207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018946870001Medicaid
PA059249Medicare PIN
PAG67805Medicare UPIN