Provider Demographics
NPI:1629941141
Name:RENGEN, SUNEETA DHUPAR (PA-C)
Entity type:Individual
Prefix:
First Name:SUNEETA
Middle Name:DHUPAR
Last Name:RENGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUNEETA
Other - Middle Name:
Other - Last Name:DHUPAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9765 ORMONDS TER
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-9706
Mailing Address - Country:US
Mailing Address - Phone:240-344-2997
Mailing Address - Fax:
Practice Address - Street 1:300 BALLENGER CENTER DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7096
Practice Address - Country:US
Practice Address - Phone:301-682-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical