Provider Demographics
NPI:1376510164
Name:MUTO, ALAN PETER (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:PETER
Last Name:MUTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 HAMILTON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4512
Mailing Address - Country:US
Mailing Address - Phone:610-433-7481
Mailing Address - Fax:610-433-3991
Practice Address - Street 1:3570 HAMILTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4512
Practice Address - Country:US
Practice Address - Phone:610-433-7481
Practice Address - Fax:610-433-3991
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005099L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0818989OtherKEYSTONE CENTRAL
PA00149306Medicaid
PA07118OtherBS
PA1000227OtherAMERI HEALTH MERCY
PA07118Medicare ID - Type Unspecified
PA00149306Medicaid