Provider Demographics
NPI:1235156787
Name:HARTWELL, AMANDA S PEARS (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S PEARS
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-4604
Mailing Address - Country:US
Mailing Address - Phone:724-475-3168
Mailing Address - Fax:
Practice Address - Street 1:162 HOLMES RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-4604
Practice Address - Country:US
Practice Address - Phone:724-475-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012171208D00000X
OH34.011612208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011993560003Medicaid
I10340Medicare UPIN
PA1011993560003Medicaid