Provider Demographics
NPI:1750343026
Name:PHANSE, MOHAN (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:
Last Name:PHANSE
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 1:80 LANDINGS DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9408
Mailing Address - Country:US
Mailing Address - Phone:724-941-3020
Mailing Address - Fax:
Practice Address - Street 1:80 LANDINGS DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9408
Practice Address - Country:US
Practice Address - Phone:724-941-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035012L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000720709002Medicaid
PAB35288Medicare UPIN
PA108119Medicare ID - Type Unspecified