Provider Demographics
NPI:1467428979
Name:LAMANTIA, JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LAMANTIA
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 1:1690 SALTSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3525
Mailing Address - Country:US
Mailing Address - Phone:724-463-7630
Mailing Address - Fax:724-463-7632
Practice Address - Street 1:1690 SALTSBURG AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3525
Practice Address - Country:US
Practice Address - Phone:724-463-7630
Practice Address - Fax:724-463-7632
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019602180003Medicaid
001759577OtherBLUE CROSS
001759577OtherBLUE CROSS
H56207Medicare UPIN