Provider Demographics
NPI:1942567078
Name:ENTINGER, JOHANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHANN
Middle Name:
Last Name:ENTINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3915
Mailing Address - Country:US
Mailing Address - Phone:610-330-9740
Mailing Address - Fax:610-432-4887
Practice Address - Street 1:2025 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:610-330-9740
Practice Address - Fax:610-432-4887
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007312213ES0103X
MA2491213EP1101X, 213ES0000X, 213ES0103X
MD01628213ES0000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery