Basic Information
| Provider Information | |||||||||
| NPI: | 1487779997 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEAL RANEN MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 175 | ||||||||
| Address2: | |||||||||
| City: | NORTHUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178570175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709880925 | ||||||||
| FaxNumber: | 5709880919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1491 S QUEEN ST | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178481600 | ||||||||
| FaxNumber: | 7178481605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 01/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | RANEN | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7178481600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD059337L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0015985810006 | 05 | PA | MEDICAID |