Provider Demographics
NPI:1497108922
Name:PONTERIO, ANDREW M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:PONTERIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SOUTH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2774
Mailing Address - Country:US
Mailing Address - Phone:724-261-5610
Mailing Address - Fax:878-295-8532
Practice Address - Street 1:540 SOUTH ST STE 301
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2774
Practice Address - Country:US
Practice Address - Phone:724-261-5610
Practice Address - Fax:878-295-8532
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058332363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1093733933OtherGROUP NPI