Provider Demographics
NPI:1689923195
Name:BRENGEL, PETER WALTER (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WALTER
Last Name:BRENGEL
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 1:341 STORY RD
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-2666
Mailing Address - Country:US
Mailing Address - Phone:724-468-3999
Mailing Address - Fax:724-468-0399
Practice Address - Street 1:341 STORY RD
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-2666
Practice Address - Country:US
Practice Address - Phone:724-468-3999
Practice Address - Fax:724-468-0399
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055571363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical