Provider Demographics
NPI:1669463774
Name:MOHAMMED, RONNIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:A
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NORMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7497
Mailing Address - Country:US
Mailing Address - Phone:717-273-6706
Mailing Address - Fax:717-273-1435
Practice Address - Street 1:755 NORMAN DRIVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7497
Practice Address - Country:US
Practice Address - Phone:717-273-6706
Practice Address - Fax:717-273-1435
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002294207R00000X
PAMD417333207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021263630001Medicaid
2054072OtherHIGHMARK BLS
PA50078092OtherCAPITAL BLUE CROSS
PA50078092OtherCAPITAL BLUE CROSS
I35041Medicare UPIN