Provider Demographics
NPI:1336159508
Name:JANERICH, ALBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DAVID
Last Name:JANERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2742
Mailing Address - Country:US
Mailing Address - Phone:570-824-4111
Mailing Address - Fax:570-824-3167
Practice Address - Street 1:901 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2742
Practice Address - Country:US
Practice Address - Phone:570-824-4111
Practice Address - Fax:570-824-3167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021055E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA506146OtherAETNA US HEALTH CARE
PA081097OtherFIRST PRIORITY HEALTH
PA1145603OtherAMERIHEALTH MERCY
PA0006919750003Medicaid
PA085038K9MOtherMEDICARE
PA104481OtherBLACK LUNG
PA000000074260OtherUNISON
PA085038OtherBLUE SHIELD
PA2193450OtherGEISINGER
PA790000014OtherPALMETTO GBA
PA0006919750003Medicaid