Provider Demographics
NPI:1073602041
Name:BENTZINGER, GREGORY MARK (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARK
Last Name:BENTZINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:610-865-1380
Mailing Address - Fax:610-865-0834
Practice Address - Street 1:251 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1209
Practice Address - Country:US
Practice Address - Phone:610-865-1380
Practice Address - Fax:610-865-0834
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004287L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02076701OtherCAPITAL
PA1517018OtherGATEWAY
PA0314119000OtherAMERIHEALTH 65
PA0728620OtherHIGHMARK
PA20010197OtherAMERIHEALTH MERCY
PA001631505Medicaid
PA02877400OtherSENIOR BLUE
PA02877400OtherKEYSTONE HEALTHPLAN CENTR
PA02877400OtherCAPITAL
PA123440OtherUNISON
PA0810OtherKEYSTONE HEALTH PLAN EAST
PA0728620OtherHIGHMARK
PA20010197OtherAMERIHEALTH MERCY
PA0810OtherKEYSTONE HEALTH PLAN EAST
PA001631505Medicaid