Provider Demographics
NPI:1578640496
Name:JOSEPH LAMANTIA, DO PC
Entity Type:Organization
Organization Name:JOSEPH LAMANTIA, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMANTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-463-7630
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001759577OtherBCBS
PA0019602180003Medicaid
PA001759577OtherBCBS
PA096752Medicare PIN