Provider Demographics
NPI:1790274967
Name:MOHAMED, SANA (DPM)
Entity Type:Individual
Prefix:
First Name:SANA
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:DPM
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:717-207-2797
Mailing Address - Fax:
Practice Address - Street 1:912 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7485
Practice Address - Country:US
Practice Address - Phone:171-272-7971
Practice Address - Fax:717-272-1241
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC007316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program