Provider Demographics
NPI:1700866027
Name:RANEN, NEAL G (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:G
Last Name:RANEN
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-0175
Mailing Address - Country:US
Mailing Address - Phone:570-988-0925
Mailing Address - Fax:570-988-0919
Practice Address - Street 1:1491 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3852
Practice Address - Country:US
Practice Address - Phone:717-848-1600
Practice Address - Fax:717-848-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059337L2084P0800X, 2084P0805X
MDD00419282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015985810006Medicaid
1322768OtherBLUE SHIELD
F34185Medicare UPIN
PA0015985810006Medicaid