Provider Demographics
NPI:1053479790
Name:PRAMANIK, REENA KAMATH (DO)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:KAMATH
Last Name:PRAMANIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-741-8180
Mailing Address - Fax:717-741-8196
Practice Address - Street 1:35 MONUMENT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-812-3712
Practice Address - Fax:717-812-2244
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0138482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101786280Medicaid
PA238779OtherUNISON-WMG
MD919374OtherCAREFIRST MD BCBS
PA1560408OtherGATEWAY-WMG
PA1920323OtherHIGHMARK BLUE SHIELD
PA20069235OtherAMERIHEALTH MERCY-WMG
PA212330OtherJOHNS HOPKINS
PA50074892OtherCAPITAL BLUE CROSS-WMG
PA7700925OtherAETNA
PA101786280Medicaid
PAP00478304Medicare PIN
PA50074892OtherCAPITAL BLUE CROSS-WMG