Provider Demographics
NPI:1801846043
Name:RENGEN, MOHAN R (DO)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:R
Last Name:RENGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 POPLAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2206
Mailing Address - Country:US
Mailing Address - Phone:717-763-0430
Mailing Address - Fax:717-763-9854
Practice Address - Street 1:899 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2206
Practice Address - Country:US
Practice Address - Phone:717-763-0430
Practice Address - Fax:717-763-9854
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013674207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017599990001Medicaid