Provider Demographics
NPI:1295738433
Name:MOHAN, CHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARUTHAIYAN
Other - Middle Name:
Other - Last Name:CHANDRAMOHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2200 S GEORGE ST
Mailing Address - Street 2:STE W-2
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4594
Mailing Address - Country:US
Mailing Address - Phone:717-741-2222
Mailing Address - Fax:717-741-2266
Practice Address - Street 1:2200 S GEORGE ST
Practice Address - Street 2:STE W-2
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4594
Practice Address - Country:US
Practice Address - Phone:717-741-2222
Practice Address - Fax:717-741-2266
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418311174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001883905Medicaid
MD615734OtherCAREFIRST MD BCBS
PA89416OtherGEISINGER
PA5436657OtherAETNA
PA102733OtherJOHNS HOPKINS
PA50093010OtherCAPITAL BLUE CROSS
PA1323323OtherHIGHMARK BLUE SHIELD
PA89416OtherGEISINGER
PA1323323OtherHIGHMARK BLUE SHIELD
PA001883905Medicaid